McKinney Maternal Test Bank for nclex

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. Which of these is a secondary sexual characteristic? a. Female breast development b. Production of sperm c. Maturation of ova d. Secretion of gonadotropin-releasing hormone

A A secondary sexual characteristic is one not directly related to reproduction, such as development of the characteristic female body form. Production of sperm, maturation of ova, and secretion of hormones are all directly related to reproduction and not secondary sexual characteristics. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 183 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

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 pregnant woman's mother is worried that her daughter is not "big enough" at 20 weeks. The nurse palpates and measures the fundal height at 20 cm, which is even with the woman's umbilicus. What should the nurse report to the woman and her mother? a. "The body of the uterus is at the belly button level, just where it should be at this time." b. "You're right. We'll inform the practitioner immediately." c. "When you come for next month's appointment, we'll check you again to make sure that the baby is growing." d. "Lightening has occurred, so the fundal height is lower than expected."

A At 20 weeks, the fundus is usually located at the umbilical level. Because the uterus grows in a predictable pattern, obstetric nurses should know that the uterus of 20 weeks of gestation is located at the level of the umbilicus. There is no need to inform the practitioner. The nurse should reassure both mother and patient that the findings are normal. The descent of the fetal head (lightening) occurs in late pregnancy. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 214 | p. 229 OBJ: Nursing Process: Implementation 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 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

6. Both members of an expectant couple are carriers for phenylketonuria (PKU), an autosomal recessive disorder. In counseling them about the risk to their unborn child, the nurse should tell them that a. the child has a 25% chance of being affected. b. the child will be a carrier, like the parents. c. the child has a 50% chance of being affected. d. one of four of their children will be affected.

A Each child born to a couple who carries an autosomal recessive trait has a 25% chance of having the disorder, because the child receives either a normal or an abnormal gene from each parent. If one member of the couple has the autosomal recessive disorder, all of their children will be carriers. If both parents are carriers, each child has a 50% chance of being a carrier. Each child has the identical odds of being affected. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: Box 10.1 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Physiologic Integrity

1. Which man is most likely to have abnormal sperm formation resulting in infertility? a. A 20-year-old man with undescended testicles b. An uncircumcised 40-year-old man c. A 35-year-old man with previously treated sexually transmitted disease d. A 16-year-old adolescent who is experiencing nocturnal emissions

A For normal sperm formation, a man's testes must be cooler than his core body temperature. The cremaster muscle attached to each testicle causes the testes to rise closer to the body and become warmer or allow the testes to fall away from the body to become cooler. Circumcision does not prevent fertility. Scar tissue in the fallopian tubes as a result of a sexually transmitted disease can be a cause of infertility in women. Nocturnal emissions of seminal fluid are normal and expected in teenagers. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 193 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

3. People who have two copies of the same abnormal autosomal dominant gene will usually be a. more severely affected by the disorder than will people with one copy of the gene. b. infertile and unable to transmit the gene. c. carriers of the trait but not affected with the disorder. d. mildly affected with the disorder.

A People who have two copies of an abnormal gene are usually more severely affected by the disorder because they have no normal gene to maintain normal function. Infertility may or may not be caused by chromosomal defects. A carrier of a trait has one recessive gene. Those mildly affected with the disorder will have only one copy of the abnormal gene. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 173 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

8. A woman tells the nurse at a prenatal interview that she has quit smoking, only has a glass of wine with dinner, and has cut down on coffee to four cups a day. What response by the nurse will be most helpful in promoting lifestyle changes? a. "You have made some great progress toward having a healthy baby. Let's talk about the changes you have made." b. "You need to do a lot better than that. You may still be hurting your baby right now." c. "Here are some pamphlets for you to study. They will help you find more ways to improve." d. "Those few things won't cause any trouble. Good for you."

A Praising her for making positive changes is an effective technique for motivating a patient. She still has to identify the risk factors to optimize the results so a discussion with the nurse can facilitate that. Telling her she has to do better is belittling to the patient. She will be less likely to confide in the nurse. The nurse is not acknowledging the efforts that the woman has already accomplished by simply giving her pamphlets. Those accomplishments need to be praised to motivate the woman to continue. Plus before giving written material, the nurse must assess the woman's literacy level. Alcohol and coffee consumption are still major risk factors and need to be addressed in a positive, nonjudgmental manner. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 180 OBJ: Nursing Process: Implementation 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

2. A nurse is teaching a woman about spinnbarkeit. The student nurse asks why the woman would need this information. What response by the nurse is most appropriate? a. To assist in becoming pregnant or preventing pregnancy b. To determine if she can breastfeed c. To assess risk for genetic defects in the fetus d. To find out if her ova are suitable for fertilization

A Spinnbarkeit refers to the elasticity of cervical mucosa. The woman can assess this to avoid or promote pregnancy. It does not refer to breastfeeding, genetics, or her ova status. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 192 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Physiologic Integrity

1. Which part of the mature sperm contains the male chromosomes? a. The head of the sperm b. The middle portion of the sperm c. X-bearing sperm d. The tail of the sperm

A The head of the sperm contains the male chromosomes that will join the chromosomes of the ovum. The middle portion of the sperm supplies energy for the tail's whip-like action. If an X-bearing sperm fertilizes the ovum, the baby will be female. The tail of the sperm helps propel the sperm toward the ovum. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 197 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Physiologic Integrity

2. One of the assessments performed in the delivery room is checking the umbilical cord for blood vessels. Which finding is considered within normal limits? a. Two arteries and one vein b. Two arteries and two veins c. Two veins and one artery d. One artery and one vein

A The umbilical cord contains two arteries and one vein to transport blood between the fetus and the placenta. Any option other than two arteries and one vein is considered abnormal and requires further assessment. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 206 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

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

4. A baby is born with blood type AB. The father is type A, and the mother is type B. The father asks why the baby has a blood type different from those of his parents. The nurse's answer should be based on the knowledge that a. both A and B blood types are dominant. b. the baby has a mutation of the parents' blood types. c. type A is recessive and links more easily with type B. d. types A and B are recessive when linked together.

A Types A and B are equally dominant, and the baby can thus inherit one from each parent. The infant has inherited both blood types from the parents; it is not a mutation. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 172 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Physiologic Integrity

4. The faculty member teaches students that which of the following are examples of autosomal recessive disorders or traits? (Select all that apply.) a. Blood group O b. Tay-Sachs disease c. Huntington disease d. Neurofibromatosis e. Hemophilia A

A, B Autosomal recessive traits and disorders include blood group O, Tay-Sachs disease, and cystic fibrosis. Huntington disease and neurofibromatosis are examples of autosomal dominant disorders. Hemophilia A is an X-linked disorder. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: Box 10.1 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Physiologic Integrity Chapter 11: Reproductive Anatomy and Physiology McKinney: Evolve Resources for Maternal-Child Nursing, 5th Edition MULTIPLE CHOICE

4. The nurse teaches parents signs that a child might be being bullied or otherwise victimized. What signs does the nurse include in this teaching? (Select all that apply.) a. Spends an inordinate amount of time in the nurse's office b. Belongings frequently go missing or are damaged. c. The child wants to be driven to school. d. School performance improves. e. The child freely talks about his day.

A, B, C Signs that may indicate a child is being bullied are similar to signs of other types of stress and include nonspecific illness or complaints, withdrawal, depression, school refusal, and decreased school performance. Children express fear of going to school or riding the school bus. Very often, children will not talk about what is happening to them. Improving school performance and talking about the day are not indications of bullying. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 147 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Psychosocial Integrity

3. The student learns about shunts that support fetal circulation. Which of the following are included in this support system? (Select all that apply.) a. Ductus venosus b. Foramen ovale c. Ductus arteriosus d. Foramen magnum e. Ductus deferens

A, B, C The ductus venosus, foramen ovale, and ductus arteriosus are part of fetal circulation. The foramen magnum is located at the base of the skull. The ductus (or vas) deferens is part of the male reproductive system. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 210 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Physiologic Integrity

4. The nursing faculty explains that the fetus can survive in a low-oxygen environment due to which of the following? (Select all that apply.) a. Fetal hemoglobin carries more oxygen than an adult's. b. The fetus has higher average hemoglobin and hematocrit. c. Hemoglobin carries more oxygen at low partial pressures of carbon dioxide. d. Fetal blood is more acidic than the maternal blood. e. The fetus does not need gas exchange while in utero.

A, B, C The fetus can survive in low oxygen environments due to its hemoglobin being able to carry more oxygen that the mom, having a higher level of hemoglobin and hematocrit, and the fact that hemoglobin can carry more oxygen at low partial pressures of carbon dioxide. Fetal blood is alkaline. The fetus does need gas exchange in utero. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 208 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Physiologic Integrity Chapter 13: Adaptations to Pregnancy McKinney: Evolve Resources for Maternal-Child Nursing, 5th Edition MULTIPLE CHOICE

1. A young female patient comes to the school nurse to discuss her irregular periods. In providing education regarding the female reproductive cycle, which phases of the ovarian cycle does the nurse include? (Select all that apply.) a. Follicular b. Ovulatory c. Luteal d. Proliferative e. Secretory

A, B, C The follicular phase is the period during which the ovum matures. It begins on day 1 and ends around day 14. The ovulatory phase occurs near the middle of the cycle, approximately 2 days before ovulation. After ovulation and under the influence of the luteinizing hormone, the luteal phase corresponds with the last 12 days of the menstrual cycle. The proliferative and secretory phases are part of the endometrial cycle. The proliferative phase takes place during the first half of the ovarian cycle when the ovum matures. The secretory phase occurs during the second half of the cycle when the uterus is prepared to accept the fertilized ovum. These are followed by the menstrual phase if fertilization does not occur. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 190 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Physiologic Integrity

1. Which demonstrates the school-age child's developing logic in the stage of concrete operations? (Select all that apply.) a. Recognizes that 1 lb of feathers is equal to 1 lb of metal b. Recognizes that he can be a son, brother, or nephew at the same time c. Understands the principles of adding, subtracting, and reversibility d. Has thinking that is characterized by egocentrism, animism, and centration e. Often solves problems with random guessing instead of logic

A, B, C The school-age child understands that the properties of objects do not change when their order, form, or appearance does. Conservation occurs in the concrete operations stage. Comprehension of class inclusion occurs as the school-age child's logic increases. The child begins to understand that a person can be in more than one class at the same time. This is characteristic of concrete thinking and logical reasoning. The school-age child is able to understand principles of adding and subtracting, as well as the process of reversibility, which occurs in the stage of concrete operations. Egocentrism, animism, and centration occur in the intuitive thought stage, as does random guessing. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: pp. 133-134 OBJ: Nursing Process: Evaluation MSC: Client Needs: Health Promotion and Maintenance

1. The nurse assesses pregnant women for exposure to human teratogens, including which of the following? (Select all that apply.) a. Infections b. Radiation c. Maternal conditions d. Drugs e. Chemicals

A, B, C, D Exposure to radiation and a number of infections may result in profound congenital deformities. These include varicella, rubella, syphilis, parvovirus, CMV, and toxoplasmosis. Certain maternal conditions such as diabetes and PKU may also affect organs and other parts of the embryo during this developmental period. Drugs such as antiseizure medication and some antibiotics, as well as chemicals including lead, mercury, tobacco, and alcohol, also may result in structural and functional abnormalities. Coffee is not considered a teratogen. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: Appendix A OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

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

5. The school nurse is evaluating the school's athletic programs for safety. What factors should the nurse assess? (Select all that apply.) a. Students get adequate rest periods. b. Equipment is in good condition. c. Practices are appropriate for students. d. Post-game concussion assessment if needed e. Adequate fluids are available at all times.

A, B, C, E A safe athletic program has several features including adequate rest periods, good quality equipment, appropriate practice schedules and regimes, and adequate fluids. Concussion testing if warranted, should occur immediately as the student is withdrawn from the game, and not wait until after the game is over. PTS: 1 DIF: Cognitive Level: Evaluation/Evaluating REF: Safety Alert Box OBJ: Nursing Process: Evaluation MSC: Client Needs: Safe and Effective Care Environment

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

7. A nurse works for an organization that seeks to limit adolescent violence. In talking with donors, which risk factors for violence may lead to programming decisions? (Select all that apply.) a. Drug or alcohol use/abuse b. Poverty c. Hopelessness about the future d. Narcissism e. Lack of supervision

A, B, C, E Drug and alcohol use/abuse, poverty, hopelessness, and lack of supervision all are risk factors for violence. Narcissism is not. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: Box 9.5 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Health Promotion and Maintenance

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

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

2. The nurse knows that which of the following chromosomal abnormalities are structural in nature? (Select all that apply.) a. Part of a chromosome is missing. b. The material within a chromosome is rearranged. c. One or more sets of chromosomes are added. d. An entire single chromosome is added. e. Two chromosomes adhere to each other.

A, B, E Characteristics of structural abnormalities include part of a chromosome missing or added, rearrangement of material within chromosomes, two chromosomes that adhered to each other, and fragility of a specific site on the X chromosome. The addition of a single chromosome (trisomy), the deletion of a single chromosome (monosomy), and one or more added sets of chromosomes (polyploidy) are numerical abnormalities. PTS: 1 DIF: Cognitive Level: Comprehension REF: pp. 175-176 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Physiologic Integrity

2. The anterior pituitary gland is responsible for producing which hormones? (Select all that apply.) a. Follicle-stimulating hormone (FSH) b. Luteinizing hormone (LH) c. Gonadotropin-releasing hormone (GnRH) d. Oxytocin e. Prolactin

A, B, E FSH and LH are both produced by the anterior pituitary gland. Both of these hormones assist in the stimulation and maturation of the ovarian follicle. Prolactin is also produced by the anterior pituitary and is required for milk production (lactogenesis) to occur. GnRH is produced by the hypothalamus and stimulates the release of FSH and LH. Oxytocin is produced by the posterior pituitary gland and is responsible for stimulating uterine contractions during birth. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: Table 11.1 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Physiologic Integrity Chapter 12: Conception and Prenatal Development McKinney: Evolve Resources for Maternal-Child Nursing, 5th Edition MULTIPLE CHOICE

8. The nurse is discussing contraceptive choices with an adolescent girl who wants to become sexually active. Which factors are important to consider? (Select all that apply.) a. Motivation b. Cognitive development c. Chronological age d. Parental opinions e. Frequency of intercourse

A, B, E Motivation, cognitive development, and planned frequency of intercourse are some of the factors to consider when counseling an adolescent about birth control choices. Chronological age is not as important as developmental state. Parents generally do not need to give consent or be informed when a teen seeks contraception. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: Nursing Quality Alert Box | Box 9.4 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance Chapter 10: Hereditary and Environmental Influences on Development McKinney: Evolve Resources for Maternal-Child Nursing, 5th Edition MULTIPLE CHOICE

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. A parent calls the emergency department (ED) reporting a front tooth completely knocked out of an adolescent's mouth while playing soccer. What information should the nurse provide? (Select all that apply.) a. Rinse the tooth in lukewarm tap water. b. Place the tooth in saline, milk, or water. c. Scrub the tooth with a disinfectant. d. Come to the ED within 1 hour. e. Prognosis is best if they are seen within 30 minutes.

A, B, E The parent should be advised to rinse the tooth in lukewarm tap water and to place it in saline, milk, or a commercial tooth preservative. Prognosis is best if the tooth can be re-implanted within 30 minutes. The tooth should not be scrubbed. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 160 OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

2. The nursing faculty teaches that the placenta produces many hormones necessary for normal pregnancy. These include (Select all that apply.) a. human chorionic gonadotropin (hCG). b. insulin. c. estrogen. d. progesterone. e. testosterone.

A, C, D The placenta produces hCG, estrogen, and progesterone. It does not produce insulin or testosterone. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 209 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Physiologic Integrity

2. Which interventions should the nurse teach that are appropriate for preventing childhood obesity? (Select all that apply.) a. Establish consistent times for meals and snacks. b. Sign your child up for sports teams. c. Teach the family and child how to prepare foods in a healthy manner. d. Show the family how to read food labels. e. Limit computer and television time.

A, C, D, E Preventing obesity includes encouraging families to establish consistent times for meals and snacks, teaching them how to select and prepare healthful foods, and limiting computer and television time. Participating in sports is a great activity, but parents should not sign their kids up for teams without consulting them first. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 144 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Health Promotion and Maintenance

3. The generalist nurse working with child-bearing families understands that his or her practice related to genetics includes which of the following? (Select all that apply.) a. Identifying families at risk and providing referrals b. Interpreting genetic test results for the family c. Assessing the couple's concern about genetic alterations d. Helping create a family tree or pedigree e. Providing support in all phases of genetic counseling

A, C, D, E The nurse who works with women and families in the childbearing years is in a wonderful position to help identify families at risk and provide referrals, assess concerns, create pedigrees, and provide support. Interpreting genetic test results is provided by those who have advanced training and education in that area and would not be expected of the generalist nurse. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 180 OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

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

1. Which factors contribute to early adolescents engaging in risk-taking behaviors? (Select all that apply.) a. Peer pressure b. A desire to master their environment c. Trying to separate from their parents d. A belief that they are invulnerable e. Impulsivity

A, D, E Peer pressure (including impressing peers) is a factor contributing to adolescent injuries. During early to middle adolescence, children feel that they are exempt from the consequences of risk-taking behaviors; they believe that negative consequences only happen to others. Feelings of invulnerability ("It can't happen to me") are evident in adolescence. Impulsivity places adolescents in unsafe situations. Mastering the environment is the task of young school-age children. Emancipation is a major issue for the older adolescent. The process is accomplished as the teenager gains an education or vocational training. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 154 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

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

8. If a woman's menstrual cycle began on June 2 and normally lasts 28 days, ovulation would mostly likely occur on June a. 10 b. 16 c. 21 d. 29

B Ovulation occurs approximately 12 to 14 days after the beginning of the menstrual period in a 28-day cycle. In this woman, ovulation would most likely occur on June 16. June 10 would just be 8 days into the cycle and too early for ovulation. June 21 would be 18 days into the cycle. Ovulation should have already occurred at this point. June 29 would be 27 days into the cycle and almost time for the next period. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 190 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

9. Many adolescents decide to follow a vegetarian diet during their teen years. The nurse can advise the adolescent and his or her parents that a. this diet will not meet the nutritional requirements of growing teens. b. a vegetarian diet can be healthy for this population. c. an adolescent on a vegetarian diet is less likely to eat high-fat foods. d. a vegetarian diet requires little extra meal planning.

B A vegetarian diet is healthy for this population, and the low-fat aspect of the diet can prevent future cardiovascular problems. Several dietary organizations have suggested that a vegetarian diet, if correctly followed, is healthy for this population. As with any adolescent, nurses need to advise teens who follow a vegetarian eating plan to avoid low-nutrient, high-fat foods. The nurse can assist with planning food choices that will provide sufficient calories and necessary nutrients. The focus is on obtaining enough calories for growth and energy from a variety of fruits and vegetables, whole grains, nuts, and soymilk. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 160 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Physiologic Integrity 10. Which is assessed with Tanner staging? a. Hormone levels b. Secondary sex characteristics c. Growth hormone secretion d. Hyperthyroidism ANS: B Tanner stages are used to assess staging of secondary sex characteristics at puberty. Hormone levels are assessed by their concentration in the blood. Growth hormone secretion tests are not associated with Tanner staging. Tanner stages are not associated with hyperthyroidism. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 151 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 11. A nurse is teaching adolescent boys about pubertal changes. The first sign of pubertal change seen with boys is a. testicular enlargement. b. facial hair. c. scrotal enlargement. d. voice deepens. ANS: A The first sign of pubertal changes in boys is testicular enlargement in response to testosterone secretion, which usually occurs in Tanner stage 2. Slight pubic hair is present and the smooth skin texture of the scrotum is somewhat altered. During Tanner stages 4 an

4. Which statement is the most appropriate advice to give parents of a 16-year-old who is rebellious? a. "You need to be stricter so that your teen stops trying to test the limits." b. "Try to collaborate to set limits that are perceived as being reasonable." c. "Increasing your teen's involvement with her peers will improve her behavior." d. "Allow your teenager to choose the type of discipline that is used in your home."

B Allowing teenagers to choose between realistic options and offering consistent and structured discipline typically enhances cooperation and decreases rebelliousness. Structure helps adolescents to feel more secure and assists them in the decision-making process. Setting stricter limits typically does not decrease rebelliousness or decrease testing of parental limits. Increasing peer involvement does not typically improve behavior. Allowing teenagers to choose the method of discipline is not realistic and typically does not reduce rebelliousness. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 157 OBJ: Integrated Process: Teaching-Learning 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

2. Which behavior suggests appropriate psychosocial development in the adolescent? a. The adolescent seeks validation for socially acceptable behavior from older adults. b. The adolescent is self-absorbed and self-centered and has sudden mood swings. c. Adolescents move from peers and enjoy spending time with family members. d. Conformity with the peer group increases in late adolescence.

B During adolescence, energy is focused within. Adolescents concentrate on themselves in an effort to determine who they are or who they will be. Adolescents are likely to be impulsive and impatient. Parents often describe their teenager as being "self-centered or lazy." The peer group validates acceptable behavior during adolescence. Adolescents move from family and enjoy spending time with peers. Adolescents also spend time alone; they need this time to think and concentrate on themselves. Conformity becomes less important in late adolescence. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 155 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

7. A woman is 16 weeks pregnant with her first baby. She asks how long it will be before she feels the baby move. The best answer is a. "You should have felt the baby move by now." b. "Within the next month, you should start to feel fluttering sensations." c. "The baby is moving, but you can't feel it yet." d. "Some babies are quiet, and you don't feel them move."

B Maternal perception of fetal movement usually begins 17 to 20 weeks after conception, particularly if this is the first pregnancy. "The baby is moving, but you can't feel it yet" is a true statement. The fetus's movements are not strong enough to be felt until 17 to 20 weeks; however, this statement does not answer the concern of the woman. If no movement is felt at the end of 20 weeks, further assessment is needed. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 204 OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

5. Which statement is true of multifactorial disorders? a. They may not be evident until later in life. b. They are usually present and detectable at birth. c. The disorders are characterized by multiple defects. d. Secondary defects are rarely associated with multifactorial disease.

B Multifactorial disorders result from an interaction between a person's genetic susceptibility and environmental conditions that favor development of the defect. They are characteristically present and detectable at birth. They are usually single isolated defects, although the primary defect may cause secondary defects. Secondary defects can occur with multifactorial disorders. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 176 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic 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

4. The nursing students learn that fertilization of the ovum takes place in which part of the fallopian tube? a. Interstitial portion b. Ampulla c. Isthmus d. Infundibulum

B The ampulla is the wider middle part of the tube lateral to the isthmus and is where fertilization occurs. It does not occur in the interstitial portion, isthmus, or infundibulum. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 188 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Physiologic Integrity

7. A 17-year-old tells the nurse that he is not having sex because it would make his parents very angry. This response indicates that the adolescent has a developmental lag in which area? a. Cognitive development b. Moral development c. Psychosocial development d. Psychosexual development

B The appropriate moral development for a 17-year-old would include evidence that the teenager has internalized a value system and does not depend on parents to determine right and wrong behaviors. Adolescents who remain concrete thinkers may never advance beyond conformity to please others and avoid punishment. Cognitive development is related to moral development, but it is not the pivotal point in determining right and wrong behaviors. Identity formation is the psychosocial development task. Energy is focused within the adolescent, who exhibits behavior that is self-absorbed and egocentric. Although a task during adolescence is the development of a sexual identity, the teenager's dependence on the parents' sanctioning of right or wrong behavior is more appropriately related to moral development. PTS: 1 DIF: Cognitive Level: Analysis/Analyzing REF: p. 158 OBJ: Nursing Process: Evaluation MSC: Client Needs: Health Promotion and Maintenance

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

5. The nursing faculty explains to students that the upper uterus is the best place for the fertilized ovum to implant because it is here that the a. placenta attaches most firmly. b. developing baby is best nourished. c. uterine endometrium is softer. d. maternal blood flow is lower.

B The uterine fundus is richly supplied with blood and has the thickest endometrium, both of which promote optimal nourishment of the fetus. If the placenta attaches too deeply, it does not easily detach after birth. Softness is not a concern with implantation; attachment and nourishment are the major concerns. The blood supply is rich in the fundus, which allows for optimal nourishment of the fetus. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 199 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Physiologic Integrity

2. The karyotype of a person is 47, XY, +21. This person is a a. normal male. b. male with Down syndrome. c. normal female. d. female with Turner syndrome.

B This person is male because his sex chromosomes are XY. He has one extra copy of chromosome 21 (for a total of 47 instead of 46), resulting in Down syndrome. A normal male has 46 chromosomes. A normal female has 46 chromosomes and XX for the sex chromosomes. A female with Turner syndrome has 45 chromosomes; the sex chromosomes have just one X. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 175 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

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. A patient at 34 weeks of gestation has reported to the OB triage unit for assessment of oligohydramnios. The nurse assigned to care for this patient is aware that prolonged oligohydramnios may result in (Select all that apply.) a. intrauterine limb amputations. b. clubfoot. c. delayed lung development. d. other fetal abnormalities. e. fetal deformations.

B, C, D Oligohydramnios, an abnormally small volume of amniotic fluid, reduces the cushion surrounding the fetus and may result in deformations such as clubfoot. Prolonged oligohydramnios interferes with fetal lung development because it does not allow normal development of the alveoli. Oligohydramnios may not be the primary fetal problem but rather may be related to other fetal anomalies. This does not lead to intrauterine limb amputations or fetal deformations. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 178 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

4. The school nurse is presenting information on some risks of tattoos. What information should the nurse provide? (Select all that apply.) a. Amateur tattoos are difficult to remove. b. Tattoos pose a risk for bloodborne and skin infections. c. A tattoo may keep you from getting an MRI. d. Tattoo dyes may cause allergic reactions. e. Tattoo parlors are well regulated.

B, C, D Tattoos carry the risk for contracting bloodborne diseases such as hepatitis B and HIV. Infection, allergic reaction to the dye, scarring, or keloid formation can occur. Should an MRI ever be required, it is important to notify the health care professionals, because the dyes can contain iron and other metals. Amateur tattoos are easily removed; however, studio tattoos made with red and green dye are extremely difficult to remove. Very little regulation exists in the tattoo industry; therefore, the cleanliness of each tattoo parlor varies. Teens should be counseled to avoid making an impulsive decision to get a tattoo. PTS: 1 DIF: Cognitive Level: Application/Applying REF: pp. 164-165 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

5. The student nurse learns that which factors place children at risk for malocclusion? (Select all that apply.) a. Sucking the thumb b. Mouth breathing c. Cleft palate d. Early loss of "baby" teeth e. Heredity

B, C, D, E Factors that contribute to malocclusion include mouth breathing, cleft palate, early loss of deciduous teeth, and heredity. Sucking the thumb is not a contributing factor unless it persists beyond 2 to 4 years. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: pp. 136-137 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Health Promotion and Maintenance Chapter 09: Health Promotion for the Adolescent McKinney: Evolve Resources for Maternal-Child Nursing, 5th Edition MULTIPLE CHOICE

6. A nurse is planning for a sports pre-participation physical exam day. What goals for this event does the nurse set? (Select all that apply.) a. Comprehensive physical examination b. Assess general health c. Identify limiting conditions d. Provide wellness counseling e. Adhere to insurance requirements

B, C, D, E In a pre-participation sports examination, goals are to identify the teen's general health, identify any condition that would limit participation, provide wellness counseling, and ensure that participants meet insurance guidelines for participation. It is not meant to be a comprehensive physical examination. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: Box 9.1 OBJ: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment

3. Which strategies can a nurse teach to parents of a child experiencing uncomplicated school refusal? (Select all that apply.) a. The child should be allowed to stay home until the anxiety about going to school is resolved. b. Parents should be empathetic yet firm in their insistence that the child attend school. c. A modified school attendance may be necessary. d. Parents need to pick the child up at school whenever the child wants to come home. e. Parents need to communicate with the teachers about the situation.

B, C, E In uncomplicated cases of school refusal, the parent needs to return the child to school as soon as possible. If symptoms are severe, a limited period of part-time or modified school attendance may be necessary. For example, part of the day may be spent in the counselor's or school nurse's office, with assignments obtained from the teacher. Parents should be empathetic yet firm and consistent in their insistence that the child attend school. Parents should not pick the child up at school once the child is there or let the child stay home until this issue is resolved. The principal and teacher should be told about the situation so that they can cooperate with the treatment plan. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 143 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Health Promotion and Maintenance

3. Parents of a teenager ask the nurse what signs they should look for if their child is in a gang. The nurse should include which signs when answering? (Select all that apply.) a. Plans to try out for the debate team at school b. Skipping classes to go to the mall c. Hanging out with friends they have had since childhood d. Unexplained source of money e. Fear of the police

B, D, E Signs of gang involvement include skipping classes, unexplained sources of money, and fear of the police. Associating with new friends while ignoring old friends is also a sign. A change in attitude toward participating in activities is another sign of gang involvement. Plans to become more involved in school activities and hanging around old friends are not signs. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: Box 9.3 OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

9. A patient states, "My breasts are so small, I don't think I will be able to breastfeed." The nurse's best response is a. "It may be difficult, but you should try anyway." b. "You can always supplement with formula." c. "Breast size is not related to the ability to breastfeed." d. "The ability to breastfeed depends on secretion of estrogen and progesterone."

C All women have approximately the same amount of glandular tissue to secrete milk, despite breast size. Saying that nursing will be difficult or that the woman can use formula does not provide the woman with accurate information. Increased estrogen decreases the production of milk. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 192 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Physiologic Integrity 10. The function of the cremaster muscle in men is to a. aid in voluntary control of excretion of urine. b. entrap blood in the penis to produce an erection. c. assist with transporting sperm. d. aid in temperature control of the testicles. ANS: D A cremaster muscle is attached to each testicle. Its function is to bring the testicle closer to the body to warm it or allow it to fall away from the body to cool it, thus promoting normal sperm production. It is not involved in urination, causing an erection or assist in transporting sperm. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 193 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity 11. The average man is taller than the average woman at maturity because of a. a longer period of skeletal growth. b. earlier development of secondary sexual characteristics. c. earlier onset of growth spurt. d. starting puberty at an earlier age. ANS: A The man's greater height at maturity is the combined result of beginning the growth spurt at a later age and continuing it for a longer period. Girls develop earlier than boys. Boys' growth spurts start at a later age. Girls start puberty approximately 6 months to 1 year earlier than boys. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 185 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 12. A student n

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

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 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

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

8. During a pregnancy group meeting, the nurse teaches patients that the fetal period is best described as one of a. development of basic organ systems. b. resistance of organs to damage from external agents. c. maturation of organ systems. d. development of placental oxygen-carbon dioxide exchange.

C During the fetal period, the body systems grow in size and mature in function to allow independent existence after birth. Basic organ systems are developed during the embryonic period. The organs are always at risk for damage from external sources; however, the older the fetus, the more resistant the organs will be. The greatest risk is when the organs are developing. The placental system is complete by week 12, but that is not the best description of the fetal period. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 204 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Physiologic Integrity

3. The parents of a 14-year-old girl are concerned that their adolescent spends too much time looking in the mirror. Which statement is the most appropriate for the nurse to make? a. "Your teenager needs clearer and stricter limits about her behavior." b. "Your teenager needs more responsibility at home." c. "During adolescence this behavior is not unusual." d. "The behavior is abnormal and needs further investigation."

C Egocentric and narcissistic behavior, such as staring at oneself in the mirror, is normal during this period of development. The teenager is seeking a personal identity. Stricter limits are not an appropriate response for a behavior that is part of normal development. More responsibility at home is not an appropriate response for this situation. The behavior is normal and needs no further investigation. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 156 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Health Promotion and Maintenance

3. The purpose of the ovum's zona pellucida is to a. make a pathway for more than one sperm to reach the ovum. b. allow the 46 chromosomes from each gamete to merge. c. prevent multiple sperm from fertilizing the ovum. d. stimulate the ovum to begin mitotic cell division.

C Fertilization causes the zona pellucida to change its chemical composition so that multiple sperm cannot fertilize the ovum. Each gamete (sperm and ovum) has only 23 chromosomes. There will be 46 chromosomes when they merge. Mitotic cell division begins when the nuclei of the sperm and ovum unite. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 195 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Physiologic Integrity

1. How can a woman avoid exposing her fetus to teratogens? a. Update her immunizations during the first trimester of her pregnancy. b. Use saunas and hot tubs during the winter months only. c. Use only class A drugs during her pregnancy. d. Use alcoholic beverages only in the first and third trimesters of pregnancy.

C In well-controlled studies, class A drugs have no demonstrated fetal risk. Immunizations, such as rubella, are contraindicated in pregnancy. Maternal hyperthermia is an important teratogen. Alcohol is an environmental substance known to be teratogenic. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 177 OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance

5. Which 16-year-old female is most likely to experience secondary amenorrhea? a. A girl who is 5 ft 2 in, 130 lb b. A girl who is 5 ft 9 in, 150 lb c. A girl who is 5 ft 7 in, 96 lb d. A girl who is 5 ft 4 in, 120 lb

C Low body fat is a risk factor for secondary amenorrhea. The girl who is 5 ft 7 inches tall and only weighs 96 pounds has less body fat that the other girls and a higher likelihood of secondary amenorrhea. PTS: 1 DIF: Cognitive Level: Analysis/Analyzing REF: p. 185 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

5. Which statement by the nurse is most appropriate to a 15-year-old whose friend has mentioned suicide? a. "Tell your friend to come to the clinic immediately." b. "You need to gather details about your friend's suicide plan." c. "Your friend's threat needs to be taken seriously and he needs immediate help." d. "If your friend mentions suicide again get your friend some help."

C Suicide is the second most common cause of death among American adolescents and young adults aged 15 to 24. A suicide threat from an adolescent serves as a dramatic message to others and should be taken seriously. Adolescents at risk should be targeted for supportive guidance and counseling before a crisis occurs. Instructing a 15-year-old to tell a friend to come to the clinic immediately provides the teen with limited information and does not address the concern. The teen should not be responsible for getting more information from the friend. Waiting until the teen discusses suicide a second time may be too late. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 163 OBJ: Integrated Process: Caring MSC: Client Needs: Psychosocial Integrity

1. The nurse is explaining Tanner staging to an adolescent and mother. Which statement best describes Tanner staging? a. Predictable stages of puberty that are based on chronologic age b. Staging of puberty based on the initiation of menarche and nocturnal emissions c. Predictable stages of puberty based on primary and secondary sexual characteristics d. Staging of puberty based on the initiation of primary sexual characteristics

C Tanner sexual-maturing ratings are based on the development of stages of primary and secondary sexual characteristics. Tanner stages are not based on chronologic age. The age at which an adolescent enters puberty is variable. The puberty stage in girls begins with breast development. Puberty stage in boys begins with genital enlargement. Primary sexual characteristics are not the basis of Tanner staging. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 151 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

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

9. A 35-year-old woman has an amniocentesis performed to find out whether her baby has a chromosome defect. Which statement by this patient indicates that she understands her situation? a. "The doctor will tell me if I should have an abortion when the test results come back." b. "I know support groups exist for parents who have a baby with birth defects, but we have plenty of insurance to cover what we need." c. "When all the lab results come back, my husband and I will make a decision about the pregnancy." d. "My mother must not find out about all this testing. If she does, she will think I'm having an abortion."

C The final decision about genetic testing and the future of the pregnancy lies with the patient. She will involve only those people whom she chooses in her decisions. The final decision about the future of the pregnancy lies with the patient only. Support groups are extremely important for parents of a baby with a defect. Insurance will help cover expenses, but the defect also takes a toll on the emotional, physical, and social aspects of the parents' lives. The nurse should ensure the woman understands that her care is confidential. PTS: 1 DIF: Cognitive Level: Evaluation/Evaluating REF: p. 180 OBJ: Nursing Process: Evaluation MSC: Client Needs: Health Promotion and Maintenance 10. Which question by the nurse will most likely promote sharing of sensitive information during a genetic counseling interview? a. "How many people in your family are mentally retarded or handicapped?" b. "What kinds of defects or diseases seem to run in the family?" c. "Did you know that you can always have an abortion if the fetus is abnormal?" d. "Are there any family members who have learning or developmental problems?" ANS: D The nurse should probe gently by using lay-oriented terminology rather than direct questions or statements. PTS: 1 DIF: Cognitive Level: Application REF: p. 180 OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance 11. A maternal-newborn nurse is caring for a mother who just delivered a baby born with Down syndrome. What nursing diagnosis is the most essential in caring for the mother of this infant? a. Disturbed body image b. Interrupted family processes c. Anxiety d. Risk for injury ANS: B This mother likely will experience a disruption in the family process related to the birth of a baby with an inherited disorder. Family disruption is common, and the stra

6. It is important for the nurse to understand that the levator ani is a(n) a. imaginary line that divides the true and false pelvis. b. basin-shaped structure at the lower end of the spine. c. collection of three pairs of muscles. d. division of the fallopian tube.

C The levator ani is a collection of three pairs of muscles that support internal pelvic structures and resist increases in intra-abdominal pressure. The linea terminalis is the imaginary line that divides the false pelvis from the true pelvis. The basin-shaped structure at the lower end of the spine is the bony pelvis. The fallopian tube divisions are the interstitial portion, isthmus, ampulla, and infundibulum. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 189 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

7. In describing the size and shape of the nonpregnant uterus to a patient, the nurse would say it is approximately the size and shape of a a. cantaloupe. b. grapefruit. c. pear. d. large orange.

C The nonpregnant uterus is approximately 7.5 × 5.0 × 2.5 cm, which is close to the size and shape of a pear. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 186 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Physiologic Integrity

2. While the nurse assesses the vital signs of a pregnant woman in her third trimester, the patient complains of feeling faint, dizzy, and agitated. Which nursing intervention is appropriate? a. Have the patient stand up and retake her blood pressure. b. Have the patient sit down and hold her arm in a dependent position. c. Have the patient lie supine for 5 minutes and recheck her blood pressure on both arms. d. Have the patient turn to her left side and recheck her blood pressure in 5 minutes.

D Blood pressure is affected by positions during pregnancy. The supine position may cause occlusion of the vena cava and descending aorta. Turning the pregnant woman to a lateral recumbent position alleviates pressure on the blood vessels and quickly corrects supine hypotension. Pressures are significantly higher when the patient is standing. This option causes an increase in systolic and diastolic pressures. The arm should be supported at the same level of the heart. The supine position may cause occlusion of the vena cava and descending aorta, creating hypotension. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 216 OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

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

7. Which statement should a nurse make when telling a couple about the prenatal diagnosis of genetic disorders? a. Diagnosis can be obtained promptly through most hospital laboratories. b. Common disorders can quickly be diagnosed through blood tests. c. A comprehensive evaluation will result in an accurate diagnosis. d. Diagnosis may be slow and could be inconclusive.

D Even the best efforts at diagnosis do not always yield the information needed to counsel patients. They may require many visits over several weeks. Some tests must be sent to a special laboratory, which requires a longer waiting period for results. There is no quick blood test available at this time to diagnose genetic disorders. Despite a comprehensive evaluation, a diagnosis may never be established. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 178 OBJ: Nursing Process: Implementation 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

8. What is the best response a nurse can make to a 15-year-old girl who has verbalized a desire to have a baby? a. "Have you talked with your parents about this?" b. "Do you have plans to continue school?" c. "Will you be able to support the baby?" d. "Can you tell me how your life will be if you have an infant?"

D Having the teenager describe how the infant will affect her life will allow the teen to think more realistically. Her description will allow the nurse to assess the teen's perception and reality orientation. Asking the teenager whether she has talked to her parents is not particularly helpful to the teen or the nurse and may terminate the communication. A direct question about continuing school will not facilitate communication. Open-ended questions encourage communication. Asking the teenager about how she will support the child will not facilitate communication. Open-ended questions encourage communication. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 166 OBJ: Nursing Process: Implementation 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 a

6. When planning care for adolescents, the nurse should a. teach parents first, and they, in turn, will teach the teenager. b. provide information for long-term health needs. c. provide explanations for treatment and procedures to the parents only. d. give information privately to adolescents on specific problems that they identify.

D Problems that teenagers identify and are interested in are typically the problems that they are the most willing to address. Confidentiality is important to adolescents. Adolescents prefer to confer privately (without parents) with the nurse and health care provider. Teenagers are socially and cognitively at the developmental stage where the health care provider can teach them. Teenagers are more interested in immediate health care needs than in long-term needs. Teenagers are at the developmental level that allows them to receive explanations about health care directly from the nurse. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 159 OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance

9. A new mother is distresses over the "white substance" covering her infant because it "looks ugly." What action by the nurse is most appropriate? a. Scrub the substance off of the baby. b. Reassure the mom that it will go away. c. Report the findings to the provider. d. Explain that the vernix caseosa protects fetal skin from amniotic fluid.

D Prolonged exposure to amniotic fluid during the fetal period could result in breakdown of the skin without the protection of the vernix caseosa. This can be washed off gently, when the baby gets the first bath. Although it will not remain, this statement does not explain the purpose of the substance. This does not need to be reported. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 204 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Health Promotion and Maintenance 10. A woman who is 16 weeks pregnant asks the nurse, "Is it possible to tell by ultrasound if the baby is a boy or girl yet?" The best answer is a. "A baby's sex is determined as soon as conception occurs, and the differences are apparent." b. "The baby has developed enough that we can determine the sex by examining the genitals through ultrasound." c. "Boys and girls look alike until approximately 20 weeks after conception, and then they begin to look different." d. "It might be possible to determine your baby's sex, but the external organs look very similar right now." ANS: B Although gender is determined at conception, the external genitalia of males and females look similar through the 9th week. By the 12th week, the external genitalia are distinguishable as male or female. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 204 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Physiologic Integrity 11. The placenta allows exchange of oxygen, nutrients, and waste products between the mother and fetus by a. contact between maternal blood and fetal capillaries within the chorionic villi. b. interaction of maternal and fetal pH levels within the endometrial vessels. c. a mixture of maternal and fetal blood within the intervillous spaces. d. passive diffusion of maternal car

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

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.

6. The student nurse learns that some of the embryo's intestines remain within the umbilical cord during the embryonic period because the a. umbilical cord is much larger at this time than it will be at the end of pregnancy. b. intestines begin their development within the umbilical cord. c. nutrient content of the blood is higher in this location. d. abdomen is too small to contain all the organs while they are developing.

D The abdominal contents grow more rapidly than the abdominal cavity, so part of their development takes place in the umbilical cord. By 10 weeks, the abdomen is large enough to contain them. The intestines remain within the umbilical cord only until approximately week 10. Intestines begin their development within the umbilical cord but only because the liver and kidneys occupy most of the abdominal cavity. All the intestines are within the abdominal cavity around week 10. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: Table 12.2 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Physiologic 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

4. While teaching an early pregnancy class, the nurse explains that the morula is a a. fertilized ovum before mitosis begins. b. flattened disk-shaped layer of cells within a fluid-filled sphere. c. double layer of cells that becomes the placenta. d. solid ball composed of the first cells formed after fertilization.

D The morula is so named because it resembles a mulberry. It is a solid ball of 12 to 16 cells that develops after fertilization. The fertilized ovum is called the zygote. This is the embryonic disk. It will develop into the baby. The placenta is formed from two layers of cells: the trophoblast, which is the other portion of the fertilized ovum, and the decidua, which is the portion of the uterus where implantation occurs. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 198 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Physiologic Integrity

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

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