Caring for Women, Families and Children across the Lifespan

An assessment of a community has been conducted. The assessment revealed that the number of serious injuries in children has doubled in the past year. Based on this information, the most appropriate community nursing diagnosis is: A. Altered family processes related to hospitalization of an injured child. B. Risk for injury related to inadequate use of bicycle helmets. C. Noncompliance related to inappropriate use of child safety seats. D. Knowledge deficit related to injury prevention in children.

Ans: D Knowledge deficit related to injury prevention in children is general to the problem as a whole and is, therefore, the most appropriate community nursing diagnosis.

A nurse, reflecting on her own sense of the meaning of wellness, identifies the seven components of wellness as a useful tool in assessing health. What are some of these components? Select all that apply. A) Physical B) Environmental C) Emotional D) Financial E) Spiritual

Answer: A, B, C, E The physical component is the ability to carry out daily tasks, achieve fitness, and generally practice positive lifestyle habits. The environmental component includes influences such as food, water, and air. The emotional component is the ability to manage stress and to express emotions appropriately. Finances are not one of the seven components of health. The spiritual component is the belief in some force (nature, science, religion, or a higher power) that serves to unite human beings and provide meaning and purpose to life.

The nurse educator is teaching a group of students about health promotion and disease prevention. Which nursing activities promote health and health maintenance? Select all that apply. A) Helping a mother determine a daily feeding schedule for her infant B) Teaching a school-age child how to use dental floss C) Teaching parents how to perform pulmonary drainage and cupping on their ill child. D) Treating a child diagnosed with pneumonia E) Administering the flu vaccine for an infant who is 9 months of age

Answer: A, B, E Administration of flu vaccines, feeding schedules, and instruction to adolescents on dental floss usage are all health promotion and/or maintenance topics. Treatment of pneumonia would not be a topic for health promotion and maintenance, as pneumonia is an acute illness. Teaching parents how to perform pulmonary drainage and cupping on their ill child is not considered health promotion and maintenance, as it is treating an acute illness.

The school nurse is preserving a tooth that was knocked out on the school playground. What will the nurse be especially careful to do? a. Wrap the tooth loosely in a clean cloth. b. Rinse the tooth with alcohol. c. Handle the tooth only by the crown. d. Place the tooth in a warm environment.

ANS: C When a permanent tooth is avulsed, the tooth should be picked up by the crown to prevent any further damage to the root and placed in milk until the child can be examined by a dentist.

What does the nurse consider as an appropriate snack for a 2-year-old child? a. Hot dog sections b. Grapes c. Popcorn d. Applesauce

ANS: D Applesauce is a healthy and safe snack food for the toddler. The toddler is at risk for choking on foods such as grapes, hot dogs, and popcorn.

The school nurse is conducting a class on bicycle safety. Which statement made by a participant indicates a need for further teaching? a. "Most bicycle injuries occur from a fall off the bicycle." b. "Head injuries are the major causes of bicycle-related fatalities." c. "I should replace my helmet every 5 years." d. "I can ride double with a friend if the bicycle has an extra large seat."

ANS: D Children should not ride double. Most injuries result from falls. The most important aspect of bicycle safety is to encourage the rider to use a protective helmet. Head injuries are the major cause of bicycle-related fatalities. The child should always wear a properly fitted helmet approved by the U.S. Consumer Product Safety Commission and should replace the helmet at least every 5 years.

The parents of a 12-month-old child ask the nurse whether the child can eat hot dogs. The nurse's reply should be based on which statement? a. Child is too young to digest hot dogs. b. Child is too young to eat hot dogs safely. c. Hot dogs must be sliced into sections to prevent aspiration. d. Hot dogs must be cut into small, irregular pieces to prevent aspiration.

ANS: D Hot dogs are of a consistency, diameter, and round shape that may cause complete obstruction of the child's airway. If given to young children, the hot dog should be cut into small irregular pieces rather than served whole or in slices. The child's digestive system is mature enough to digest hot dogs. To eat the hot dog safely, the child should be sitting down, and the hot dog should be appropriately cut.

Motor vehicle injuries are a significant threat to young children. Knowing this, the nurse plans a teaching session with a toddler's parents on car safety. Which will she 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 be fit snugly. d. Place the car safety seat in the front passenger seat equipped with an air bag. e. After the age of 2 years, toddlers can be placed in a forward-facing car seat.

ANS: A, C, E Toddlers younger than 2 years should be secured in a rear-facing, upright, approved car safety seat. After the age of 2 years, a forward-facing car seat can be used. Harness straps should be adjusted to provide a snug fit. 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 air bag.

The most fatal type of burn in the toddler age-group is: a. Flame burn from playing with matches. b. Scald burn from high-temperature tap water. c. Hot object burn from cigarettes or irons. d. Electric burn from electrical outlets.

ANS: A Flame burns from matches and lighters represent one of the most fatal types of burns in the toddler age-group. Scald burns from water, hot object burns from cigarettes or irons, and electric burns from outlets are all significant causes of burn injury. The child should be protected from these causes by reducing the temperature of the hot water in the home, keeping objects such as cigarettes and irons away from children, and placing protective guards over electrical outlets when not in use.

What tasks would be appropriate to expect of a 5-year-old? a. Setting the table with paper plates b. Washing the dirty knives c. Carrying glasses from the table to the sink d. Scrubbing out the sink with cleanser

ANS: A Parents must consider developmental level and safety when asking the 5-year-old child to help with chores.

Which statement best describes fear in school-age children? a. They are increasingly fearful for body safety. b. Most of the new fears that trouble them are related to school and family. c. They should be encouraged to hide their fears to prevent ridicule by peers. d. Those who have numerous fears need continuous protective behavior by parents to eliminate these fears.

ANS: B During the school-age years, children experience a wide variety of fears, but new fears related predominantly to school and family bother children during this time. During the middle-school years, children become less fearful of body safety than they were as preschoolers. Parents and other persons involved with children should discuss their fear with them individually or as a group activity. Sometimes school-age children hide their fears to avoid being teased. Hiding the fears does not end them and may lead to phobias.

An important consideration for the school nurse who is planning a class on bicycle safety is: a. Most bicycle injuries involve collision with an automobile. b. Head injuries are the major causes of bicycle-related fatalities. c. Children should wear bicycle helmets if they ride on paved streets. d. Children should not ride double unless the bicycle has an extra-large seat.

ANS: B The most important aspect of bicycle safety is to encourage the rider to use a protective helmet. Head injuries are the major cause of bicycle-related fatalities. Although motor vehicle collisions do cause injuries to bicyclists, most injuries result from falls. The child should always wear a properly fitted helmet approved by the U.S. Consumer Product Safety Commission. Children should not ride double.

When teaching injury prevention during the school-age years, the nurse should include: a. Teaching the need to fear strangers. b. Teaching basic rules of water safety. c. Avoiding letting children cook in microwave ovens. d. Cautioning children against engaging in competitive sports.

ANS: B Water safety instruction is an important source of injury prevention at this age. The child should be taught to swim, select safe and supervised places to swim, swim with a companion, check sufficient water depth for diving, and use an approved flotation device. Teach stranger safety, not fearing strangers. This includes not going with strangers, not having personalized clothing in public places, having children tell parents if anyone makes them uncomfortable, and teaching children to say "no" in uncomfortable situations. Teach children safe cooking methods. Caution against engaging in hazardous sports, such as those involving trampolines.

The nurse discusses child-proofing the home for safety with the mother of a 9-month-old. Which statement made by the mother would indicate an unsafe behavior? a. "I put covers on all of the electrical outlets." b. "In the car, she rides in a front-facing car seat." c. "There are locks on all of the cabinets in the house." d. "I have a gate at the top and bottom of the stairs.

ANS: B A rear-facing infant car seat should be used for infants younger than 1 year of age.

On a home visit, the nurse notes that the parents require teaching intervention to protect the 15-month-old child who lives there. What observation would lead the nurse to this conclusion? a. The fireplace has a screen. b. The dining room table has a tablecloth on it. c. There are paintings on the wall. d. The kitchen floor is clean but not shiny.

ANS: B A tablecloth presents a safety hazard because the curious toddler will reach up and pull on it. The toddler could be injured if items on the table are moved when the tablecloth is pulled

During the preschool period, the emphasis of injury prevention should be placed on: a. Constant vigilance and protection. b. Punishment for unsafe behaviors. c. Education for safety and potential hazards. d. Limitation of physical activities.

ANS: C Education for safety and potential hazards is appropriate for preschoolers because they can begin to understand dangers. Constant vigilance and protection is not practical at this age since preschoolers are becoming more independent. Punishment may make children scared of trying new things. Limitation of physical activities is not appropriate.

The nurse is educating a group of preschool parents about the importance of safety. Which statement by a parent indicates the need for further education? a. "I continue to provide a great deal of indirect supervision for my child." b. "My stairway is always free of clutter." c. "I only leave my child in the car for brief moments." d. "Medications are kept in a locked cabinet."

ANS: C Children must not play in or around the car or be left alone, even for a brief moment, in the car. Preschool children still require a good deal of indirect supervision to protect them from dangers that arise from their immature judgment or social environment. Stairways should be free of clutter and medications kept out of reach.

Small-for-gestational-age infants often have complications at birth, but they may also experience long-term complications. The long-term effect that is most likely to occur in SGA infants is: Choice 1 Change from thin and underweight as a child to overweight or obese as adolescents Choice 2 Poor fine motor coordination Choice 3 Paralysis below the hips Choice 4 Permanent disfiguration

Ans 2 SGA infants are likely to develop cognitive disabilities such as poor fine motor coordination, hyperactivity, learning disabilities, and hearing loss. This long-term effect is often seen in children with fetal alcohol syndrome, not SGA. Many infants with myelomeningocele will suffer life-long paralysis below the site of the cyst. Paralysis is not generally associated with SGA infants. Although it may occur, disfiguration is not commonly associated with SGA infants. Instead, disfiguration is more likely to remain in infants with congenital anomalies such as cleft lip/cleft palate, even after corrective surgery.

A 38-week newborn is found to be small for gestational age. Which of the following nursing interventions should be included in the care of this newborn? A. Monitor for feeding difficulties B. Assess for facial paralysis C. Monitor for signs of hyperglycemia D. Maintain a warm environment

Ans. D Hypothermia is a common complication of the SGA newborn; therefore, the newborn's environment must remain warm to decrease heat loss. LGA newborns are more difficult to arouse to a quiet alert state and can have feeding difficulties. LGA newborns often are prone to birth trauma, such as facial paralysis, due to cephalopelvic disproportion. SGA newborns are more prone to hypoglycemia

The school health nurse is evaluating the home environments of several children as they relate to child safety. The nurse visits the home of each child and gathers the following data. Which of these activities places a child at the greatest risk for bodily harm? A. The parents are in a methadone program B. The parents consume alcohol on a daily basis C. The child is a latchkey child. D. The child is permitted to take target practice with a revolver unsupervised.

Ans. D Of all the activities mentioned, the child who is playing with guns is most at risk for injury. Drug and alcohol use or past use also place the child at risk, but the use of firearms is more risky. A latchkey child needs special attention, but among the situations given is not at the highest risk.

While interviewing the parents of a 2-year-old female, the nurse notes that the mother is pregnant. At the end of the visit, the nurse decides to give a new pamphlet to the parents about car seat usage for newborns. This action is an example of: A. Secondary preventative health maintenance. B. Developmental screening C. Tertiary preventative health maintenance. D. Primary preventative health maintenance.

Ans. D The teaching regarding proper car seat use is an example of an activity that might decrease the opportunity for injury in a newborn; therefore, this is primary preventive health maintenance. The secondary level of prevention is focused on diagnosis of a problem, usually medical in nature, in order to address it and make a plan of care. This is education, and not a developmental screening to elicit data. The focus of the teaching is on an unborn child, so developmental level is not a current issue. The tertiary level of preventative care is related to restoring a level of functioning that is below an expected level, such as in a rehabilitation situation.

A 2-month-old infant with bronchopulmonary dysplasia is being prepared for discharge from the neonatal intensive care unit. He will continue to receive oxygen via nasal cannula at home. Prior to discharge, the home health nurse assesses the home. Which of the following findings poses the greatest risk to this infant? A. Paint peeling on the walls B. A wood stove used for heating C. A sibling who has an ear infection D. Small toys strewn on the floor

Ans: B Assessment of the home environment is essential prior to discharge of a medically fragile infant. The use of a wood stove poses great risk to the infant who already has fragile lungs. Paint peeling from the wall will pose a choking risk to the older infant who is crawling. Ear infections are not contagious. Small toy pieces will pose a choking risk to the older infant who is crawling.

What would be the best way for the nurse to teach adolescents regarding health promotion and health maintenance? A. Contact the parents and ask what issues they have with their adolescents. B. Have the adolescents identify a personal health goal. C. Ask the advice of the counselors at school. D. Tell the adolescents what you will include in the lecture

Ans: B Teaching topics will be directed at both health promotion and health maintenance. A good starting point is to have the adolescent identify a personal health goal, and begin teaching there. Talking to the parents first is not necessary. Common issues that arise for adolescents should be discussed in general and not according to specific individuals. It is not necessary for the nurse to ask the counselors at school for advice on health topics. Lecturing an adolescent group is not as effective as having an honest and open discussion with adequate time for questions

The nurse is assessing a small-for-gestational-age newborn who had an older sibling who died of sudden infant death syndrome. Knowing this, the nurse must include which in the plan of care for the newborn? A. Encourage the parents to sleep with the infant for close observation B. Encourage the parents to place the infant on his abdomen to sleep. C. Encourage the parents to place the infant in a crib with a tight-fitting, firm mattress. D. Encourage the parents to place the infant in a crib with a soft mattress with extra blankets.

Ans: C Placing the infant in a crib with a tight-fitting, firm mattress will help keep the infant's mouth free of obstructions. Placing the infant in a crib with a tight-fitting, firm mattress will help keep the infant's mouth free of obstructions. Research has shown that supine is the safest sleeping position for infants. "Back to Sleep" and "Face Up to Wake Up" campaigns are designed to educate the public that infants should be placed on their backs for sleeping. Quilts, blankets, and other soft items should not be used in baby beds. Put the infant in a blanket sleeper instead.

Which observation in a health supervision visit leads nurse to have concerns about the infant's mental health? A. The parent swaddles her 1-month-old, who is crying after an immunization B. When the nurse reaches for a 9-month-old, the infant grabs her mother and cries. C. A 9-month-old avoids eye contact with parents and the nurse. D. A 10-month-old reportedly sleeps about 12 hour total per night.

Ans: C The nurse should expect the 9-month-old to have eye contact with the parents and the nurse. If no eye contact is made, the nurse should implement a more detailed assessment of the infant's mental health. A 10-month-old reportedly sleeps about 12 hour total per night. Other choices are normal for this age group.

A pediatric nurse is caring for a 2-year-old client at a well-child clinic. Teaching for the client's parents regarding the client's oral health will include: Select all that apply. A) Parental smoking cessation resources. B) Instructions on brushing the client's teeth once daily. C) Hazards of fluoride use in tooth development. D) Instructions on eliminating the client's milk consumption. E) Instructing the parents that the client needs dental care prior to when the client begins to lose the primary teeth.

Answer: A, E Explanation: A) Many parents are unaware of the importance of dental health in very young children. They may see their child's teeth as "baby teeth" and think they can put off dental visits until the child begins to lose the primary teeth. Nurses working with parents of very young children may need to help parents learn that care of primary teeth is essential to healthy permanent teeth. Providing the client's parents with smoking cessation resources is essential, as secondhand smoke leads to dental caries. The client's teeth should be brushed twice daily and after meals. The client does not need to eliminate milk consumption. Fluoride should be utilized for those with non-fluoridated water and does not pose a risk in tooth development.

The nurse is visiting a family in the home to conduct a risk assessment. The family has a toddler and a preschool-aged child. What would be considered a safety hazard? A) Safety plugs in electrical outlets B) Medications on the kitchen counter C) Lack of helmets next to bicycles D) Deadbolt locks on the doors

Answer: B Explanation: The nurse would instruct the parents to keep medications out of the children's reach. Medication poisoning happens easily with young toddlers and preschool-age children who think the medication is candy. Safety plugs are appropriate for this age group. Deadbolt locks are appropriate to keep toddlers from wandering out to the street. A lack of a helmet next to a bike does not mean there are no helmets in the house. This finding would cause the nurse to ask more questions but is not considered a definite safety risk.

A 6-year-old child is being seen in a pediatric clinic for a well-child checkup. The parent tells the nurse that they live in the country and use well water. Which statement by the nurse is a priority to include in client teaching? A) "Your child will need to use a teeth whitener in the future because well water is your primary water source." B) "Your child will need to be placed on a fluoride supplement because your primary water source is from a well." C) "I will recommend some mouthwashes that are appropriate for clients that drink well water." D) "It will be very important that your child does not eat sugary foods because you drink well water."

Answer: B Teeth whitener or special mouthwashes are not required for a child who drinks well water. Inquire about use of fluoride if the water supply is not fluoridated. Well water does not contain fluoride. Refraining from sugary foods is not necessary just because the child's primary drinking source is from a well. While the nurse may teach about the effect of sugary foods on teeth, the priority would be to teach about fluoride, since this family's water supply does not provide it.

The nursing instructor is educating a group of nursing students on sports-related injuries. Which comment made by a student nurse would indicate to the nursing instructor the need for further instruction? A) "Clients who participate in sports, strenuous exercise, or athletics of any kind should be educated about the dangers of unreported head injuries." B) "Adolescents are at the greatest risk for not reporting sports-related injuries." C) "Young adults are at the greatest risk for not reporting sports-related injuries." D) "Clients who have been injured playing a sport need to be counseled on the risks of unreported concussions."

Answer: C Explanation: A) Clients who participate in sports, strenuous exercise, or athletics of any kind should be educated about the dangers of unreported head injuries. Adolescents are at the greatest risk for not reporting sports-related injuries, but adults should be educated about the dangers as well. Clients who have been injured playing a sport, or even those receiving a sports physical, could be counseled by nurses about the risks of unreported concussions.