Ch 31 Children & Adolescents

2. When assessing adolescent girls, the nurse should know that which of the following usually appears first? A) Pubic hair B) Breast buds C) Axillary hair D) Menses onset

B) Breast buds

7. A 4-year-old boy is brought to the emergency department by his parents, who state that he has been crying and saying his tummy hurts. Which method would be most appropriate for the nurse to initially assess the problem? A) Ask the child to point with one finger where it hurts. B) Inspect, palpate, percuss, and then auscultate the abdomen. C) Determine the time and character of the child's last bowel movement. D) Ask the child to describe the character of his pain.

A) Ask the child to point with one finger where it hurts.

23. The nurse's assessment of a child's hair reveals that it is clean and neatly trimmed but exceptionally dry and brittle. What is the nurse's best response to this finding? A) Assess the child for signs and symptoms of impaired nutrition. B) Assess the child for indications of abuse or neglect. C) Facilitate a referral to a dermatologist. D) Encourage the child's mother to ensure that the child gets adequate exposure to sunlight.

A) Assess the child for signs and symptoms of impaired nutrition.

30. A nurse is having difficulty getting a 14-year-old child to open up during the health interview. What strategy is most likely to enhance the nurse's communication with this child? A) Give the child some control over the course and content of the interview. B) Teach the child about the negative consequences of an inadequate interview. C) Arrange for one of the child's parents to speak with him or her privately. D) Promise the child a reward for participating in the interview.

A) Give the child some control over the course and content of the interview.

10. Which technique should the nurse use to perform scoliosis screening in a school-age child? A) Have the child bend forward at the waist. B) Measure the length of each of the child's legs. C) Measure the distance between the child's knees and ankles. D) Ask the child to walk across the room.

A) Have the child bend forward at the waist.

24. The nurse's inspection of a young child's anus reveals the presence of hemorrhoids. How should the nurse best interpret this assessment finding? A) Hemorrhoids are unusual in children and warrant further assessment. B) Hemorrhoids are a common indication of deficient fluid intake in children. C) Hemorrhoids are common in children until they attain bowel continence. D) Hemorrhoids in a child younger than 10 are suggestive of colorectal cancer.

A) Hemorrhoids are unusual in children and warrant further assessment.

9. A school nurse plans to test hearing acuity in students who range between kindergarten and sixth grade. Which of the following would be most appropriate method? A) Loud noise screening B) Audiometry C) Whisper test D) Weber test

B) Audiometry

17. The nurse assesses the respiratory rate of a 5-year-old boy. Which finding would indicate to the nurse that his rate is within the age-appropriate range for this child? A) 16 breaths/minute B) 24 breaths/minute C) 32 breaths/minute D) 40 breaths/minute

B) 24 breaths/minute

26. The nurse is assessing a 6-year-old child. While auscultating the child's apical heart rate, the nurse notes that the child's heart rate increases during inspiration. What is the nurse's most appropriate action? A) Arrange for a STAT electrocardiogram. B) Document this as an expected assessment finding. C) Facilitate a referral for medical assessment. D) Reposition the child and then reassess.

B) Document this as an expected assessment finding.

15. When the nurse palpates the abdomen of a preschool boy, he begins to giggle and draw his legs up onto his abdomen. Which of the following would be most appropriate for the nurse to do? A) Omit the entire abdominal exam. B) Palpate with the child's hand under the nurse's hand. C) Ask the parent to discipline the child. D) Explain the purpose of the exam to the child.

B) Palpate with the child's hand under the nurse's hand.

20. After inspecting an adolescent male's genitalia, the nurse documents the findings as Tanner stage 3. Which of the following findings would be most likely? A) Scrotum and testes slightly enlarged; sparse, long, downy pubic hair B) Penis elongated; pubic hair sparse over pubis, coarse and curly C) Penis increased in width; abundant pubic hair not extending to thighs D) Penis of adult size; dark curly abundant pubic hair to thighs

B) Penis elongated; pubic hair sparse over pubis, coarse and curly

22. The nurse has assessed the head circumference (HC) of an 18-month-old during a regular checkup. The nurse should compare the percentile of the child's HC to which of the following? A) The child's body mass index B) The child's height and weight percentiles C) The child's chest circumference percentile D) The child's developmental stage

B) The child's height and weight percentiles

1. A preadolescent girl comes to the clinic for a sports physical exam. The nurse notes beginning breast development and documents which of the following? A) Gynecomastia B) Thelarche C) Menarche D) Adolescence

B) Thelarche

12. A mother voices concern about the amount of time her school-age child sleeps. When responding to the mother, the nurse understands that this age group sleeps an average of how many hours each night? A) 11 to 12 B) 9 to 10 C) 8 to 9.5 D) 7 to 8

C) 8 to 9.5

3. When describing cultural differences related to tooth eruption, the nurse explains that permanent teeth typically appear earlier in which group? A) Caucasians B) Hispanics C) African Americans D) Native Americans

C) African Americans

18. A nurse is providing an in-service presentation to a group of new pediatric nurses and reviewing differences in assessment of children and adults. When describing the heart sound typically auscultated in children in comparison to an adult, which characteristic would the nurse describe? A) Children typically have softer heart sounds. B) Children typically have less harsh heart sounds. C) Children typically have higher pitched heart sounds. D) Children typically have heart sounds of longer duration.

C) Children typically have higher pitched heart sounds.

6. The nurse has identified a need to discuss sexuality with a 15-year-old client. How should the nurse best plan this aspect of the health interview? A) Obtain informed consent for the health interview. B) Begin by explaining appropriate and acceptable sexual behavior. C) Discuss the matter when a parent is not present. D) Ensure that a chaperone is in the room during the interview.

C) Discuss the matter when a parent is not present.

21. The pediatric nurse is obtaining the nursing history of a 4-year-old girl who is accompanied by her mother. What question should the nurse pose to the child's mother? A) Is your daughter able to pick out her name from a page of writing? B) Do you think your daughter can see others' points of view? C) Does your daughter often ask 'why'? D) Does your daughter like to collect things?

C) Does your daughter often ask 'why'?

25. The nurse inspects a 10-day-old infant's umbilicus and notes that it is reddened with the presence of slight discharge. What nursing diagnosis is suggested by these data? A) Risk for contamination B) Ineffective peripheral tissue perfusion C) Infection D) Risk for injury

C) Infection

19. A nurse has completed an assessment of a school-age child. The nurse has identified several soft signs of potential neurologic impairment. How should the nurse best interpret these findings? A) Recognize that the findings are related to developmental tasks rather than neurologic pathology B) Recognize the need for an emergency neurological assessment C) Recognize that the findings may or may not indicate the presence of a neurologic problem D) Recognize that the findings need to be interpreting in light of the child's education level

C) Recognize that the findings may or may not indicate the presence of a neurologic problem

13. The nurse is teaching a group of parents of children of various ages how to best measure a child's temperature. The nurse instructs the parents that rectal temperature measurement is indicated in which situation? A) During the newborn period B) When a child is dehydrated C) When no other route is feasible D) When rapid temperature changes occur

C) When no other route is feasible

16. The nurse is participating in a vision-screening program for children age 3 to 10 years. The nurse would expect a child to have 20/20 vision at what age? A) 3 to 4 B) 4 to 5 C) 5 to 6 D) 6 to 7

D) 6 to 7

8. A nurse is conducting a workshop with a group of adults who are enrolled in a parenting class. Which of the following would the nurse emphasize as important in helping the school-age child achieve the psychosocial task of industry and avoid inferiority? A) Allow independence B) Encourage competition C) Increase socialization D) Acknowledge accomplishments

D) Acknowledge accomplishments

11. During the health history, a nurse asks a mother to describe the play activities of her school-age son. The mother reports activities that are typical for this age group. The nurse would document this as which type of play? A) Imitative B) Associative C) Parallel D) Competitive

D) Competitive

27. The school nurse is assessing a 15-year-old client. The nurse should understand that this child's current priorities will most likely reflect what developmental task? A) Exerting influence B) Learning new information C) Becoming productive D) Developing a personal identity

D) Developing a personal identity

29. The nurse is experiencing challenges in eliciting information during the health interview of a 4-year-old boy. How can the nurse best foster communication with the child? A) Set a time limit for completing the interview. B) Ask the child to talk about himself in the third person. C) Explain the purpose of the interview in simple terms. D) Engage the child in play.

D) Engage the child in play.

28. The nurse is meeting the parents of an ill child for the first time and is preparing to perform the health interview. In addition to gathering health data, what additional goal should the nurse prioritize during this interaction? A) Gauge the parents' own levels of health. B) Emphasize the importance of adherence to treatment. C) Identify the family's socioeconomic status. D) Foster trust with the child's parents.

D) Foster trust with the child's parents.

4. Which finding would require further evaluation or referral when auscultating heart sounds on an 8-year-old client during a routine physical exam? A) Audible S3 B) Soft systolic murmur C) Sinus arrhythmia D) Pulse rate 120 beats per minute

D) Pulse rate 120 beats per minute

14. During a well-child visit, a parent asks the nurse the best way to manage negativism in her toddler. Which suggestions by the nurse would be most appropriate? A) Implement punishment appropriate for the child's age. B) Spend more quality time with the child. C) Repeatedly tell the child not to always say no. D) Reduce the opportunities for a no answer.

D) Reduce the opportunities for a no answer.

5. During palpation of a young child's abdomen, the nurse assesses the liver. Which of the following would the nurse expect to find? A) The liver can be palpated 4 cm below the right costal margin. B) The liver is not palpable. C) The liver is found at the left costal margin. D) The liver is located 2 cm below the right costal margin.

D) The liver is located 2 cm below the right costal margin.