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Review Questions from Chapter 1-13
Terms in this set (101)
During a presentation on prenatal care, the student nurse stated, "In 2000 the maternal mortality rate for African-American women was 22." The number "22" in this statement means there have been
a. 22 serious maternal illness per 1,000 live births
b. 88 serious maternal illness per 100 live births
c. 88 maternal deaths per 100 live births
d. 22 maternal deaths per 100,000 live births
a. 22 serious maternal illness per 1,000 live births
b. 88 serious maternal illness per 100 live births
c. 88 maternal deaths per 100 live births
d. 22 maternal deaths per 100,000 live births
A woman is giving birth to her third child in a setting that allows her husband and children to be actively involved in the process. The nurse caring for her must also consider the husband and the two children as patients and work to meet their needs. This type of setting is termed
a. emergency care
b. family-centered care
c. hospice care
d. individual care
a. emergency care
b. family-centered care
c. hospice care
d. individual care
b. family-centered care
Family-centered care is any setting where the pregnant woman and her family are treated as one unit. The nurse assumes a major role in teaching, counseling, and supporting the family. In emergency care settings, the nurse deals primarily with the patient who is having difficulty. In hospice care settings, the nurse deals with patients who have terminal illnesses. Individual care deals only with the patient and does not include the family.
Family-centered care is any setting where the pregnant woman and her family are treated as one unit. The nurse assumes a major role in teaching, counseling, and supporting the family. In emergency care settings, the nurse deals primarily with the patient who is having difficulty. In hospice care settings, the nurse deals with patients who have terminal illnesses. Individual care deals only with the patient and does not include the family.
A 27-year-old pregnant woman is seeing a nurse-midwife for prenatal care. Her first baby was born by cesarean because the baby was too large to fit through the woman's pelvis. She has also developed gestational diabetes during this pregnancy. When discussing with the woman her options for places of birth, what is the best choice for her?
a. It does not matter
b. birth center
c. home birth
d. LDR in a hospital setting
a. It does not matter
b. birth center
c. home birth
d. LDR in a hospital setting
d. LDR in a hospital setting
Home births and freestanding birthing centers should be used for patients with very low risk for complications. The woman's past history and present complication with this pregnancy place her in a high-risk category. Therefore, she needs to be in a setting where emergency care is quickly available. Because of her complications, the woman is not a candidate for home birth or a birth center. The woman needs to be in a setting where emergency care is quickly available.
Home births and freestanding birthing centers should be used for patients with very low risk for complications. The woman's past history and present complication with this pregnancy place her in a high-risk category. Therefore, she needs to be in a setting where emergency care is quickly available. Because of her complications, the woman is not a candidate for home birth or a birth center. The woman needs to be in a setting where emergency care is quickly available.
A 4-year-old is hospitalized for treatment of pneumonia. The nurse informs the child's mother that the pediatric unit is a Family-Centered Child Care unit. What does this mean for her?
a. she will be responsible for her child's total care
b. she will not be able to stay at night with her child but must stay during the day
c. she will be asked for input into her child's care
d. she will not be allowed to visit her child, because it is considered to cause emotional distress
a. she will be responsible for her child's total care
b. she will not be able to stay at night with her child but must stay during the day
c. she will be asked for input into her child's care
d. she will not be allowed to visit her child, because it is considered to cause emotional distress
c. she will be asked for inout into her child's care
Family-Centered Child Care recognizes and respects the pivotal role of the family in the child's life. It supports families and views parents and professionals as equal partners. Family-Centered Child Care units encourage parents to stay with the child around the clock. The child's mother will share care of the child as the parents and professionals are viewed as equals.
Family-Centered Child Care recognizes and respects the pivotal role of the family in the child's life. It supports families and views parents and professionals as equal partners. Family-Centered Child Care units encourage parents to stay with the child around the clock. The child's mother will share care of the child as the parents and professionals are viewed as equals.
A 27-year-old woman newly diagnosed with diabetes is admitted to an agency to regulate her medication and receive patient teaching on diabetes. She is assigned a case manager on her first day. To best explain this role to the woman, the nurse states that a case manager will
a. decide which method of treatment is most cost effective for the agency.
b. manage and collaborate the woman's care to ensure optimal outcomes.
c. decide which patient teaching is necessary for the woman.
d. be responsible for reviewing the woman's chart for errors.
a. decide which method of treatment is most cost effective for the agency.
b. manage and collaborate the woman's care to ensure optimal outcomes.
c. decide which patient teaching is necessary for the woman.
d. be responsible for reviewing the woman's chart for errors.
b. manage and collaborate the woman's care to ensure optimal outcomes.
A case manager will focus on both quality and cost outcomes. He or she will coordinate services needed and manage the care collaboratively to ensure optimal outcomes. The case manager will coordinate the patient teaching, not decide which patient teaching is necessary for the woman. The quality assurance team is responsible for reviewing the woman's chart for errors. The case manager is concerned about cost effectiveness, but the main focus is to ensure quality outcomes.
A case manager will focus on both quality and cost outcomes. He or she will coordinate services needed and manage the care collaboratively to ensure optimal outcomes. The case manager will coordinate the patient teaching, not decide which patient teaching is necessary for the woman. The quality assurance team is responsible for reviewing the woman's chart for errors. The case manager is concerned about cost effectiveness, but the main focus is to ensure quality outcomes.
A woman brings her two sons, ages 2 and 4, to the health clinic. She tells the nurse that they have been in the United States for only 1 year and are homeless. Because of this history, the nurse will assess the children for infections and
a. malnutrition
b. congenital defects
c. accelerated growth patterns
d. allergies
a. malnutrition
b. congenital defects
c. accelerated growth patterns
d. allergies
The nurse has been assigned to care for a patient during the night shift. The patient's medication to prevent seizures was due at 6 AM. At that time the nurse was involved with another patient and did not administer the medication. At 10 AM, the patient ambulated to the bathroom, had a seizure, fell, and later developed brain damage as a result of the fall. The nurse can be sued for
a. civil tort
b. malpractice
c. nothing, the nurse is immune because she was assisting another patient.
d. abandonment
a. civil tort
b. malpractice
c. nothing, the nurse is immune because she was assisting another patient.
d. abandonment
b. malpractice
Malpractice has four elements that must be proved: a duty (the nurse was assigned to care for the patient), breach of duty (the nurse did not render care by neglecting the medication); damage (the patient suffered brain damage); proximate cause (brain damage was due to the fall during the seizure). Abandonment would have occurred if the nurse had not provided any care for the patient or if the nurse had walked away from his or her job. A civil tort is a civil wrong or injury. The nurse is not immune if she neglects one patient for another.
Malpractice has four elements that must be proved: a duty (the nurse was assigned to care for the patient), breach of duty (the nurse did not render care by neglecting the medication); damage (the patient suffered brain damage); proximate cause (brain damage was due to the fall during the seizure). Abandonment would have occurred if the nurse had not provided any care for the patient or if the nurse had walked away from his or her job. A civil tort is a civil wrong or injury. The nurse is not immune if she neglects one patient for another.
The role of the pediatric nurse is influenced by trends in health care. What is the current trend in child health care?
a. Accountability to professional codes and international standards
b. Primary focus on treatment of disease or disability
c. National health care planning on a distributive or an episodic basis
d. Focus on health promotion—the provision of care designed to keep people healthy and prevent illness
a. Accountability to professional codes and international standards
b. Primary focus on treatment of disease or disability
c. National health care planning on a distributive or an episodic basis
d. Focus on health promotion—the provision of care designed to keep people healthy and prevent illness
d. Focus on health promotion—the provision of care designed to keep people healthy and prevent illness
This is the current focus of health care in which nursing plays a major role. The treatment of disease or disability is traditionally the role of the physician. National health care planning is not a major trend. Accountability to professional codes and international standards is an established responsibility, not a trend.
This is the current focus of health care in which nursing plays a major role. The treatment of disease or disability is traditionally the role of the physician. National health care planning is not a major trend. Accountability to professional codes and international standards is an established responsibility, not a trend.
b, c, d
The nurse's primary function was to follow medical orders, so teaching was not valued. Strong medications were given to the patient that left her heavily sedated. Fathers were usually sent to the waiting room. The use of lay midwives was declining at this time and nurse-midwives were not well established.
The nurse's primary function was to follow medical orders, so teaching was not valued. Strong medications were given to the patient that left her heavily sedated. Fathers were usually sent to the waiting room. The use of lay midwives was declining at this time and nurse-midwives were not well established.
An experienced maternity nurse needs to teach a new mother about bottle feeding. The mother is 25 years old and has a 2-year-old that she also bottle fed. She has been in the United States for 1 year and has a limited understanding of the English language. What factors will negatively influence the learning process and will cause the nurse to alter her teaching techniques?
a. Organization and skill of the teacher
b. Language and culture
c. Physical environment
d. Developmental level and previous experiencesb. Language and culture
The new mother is from a different culture and has English as a second language. The nurse will need to alter her teaching methods to accommodate these two factors to ensure learning. At 25 years of age, the mother has the developmental ability to learn. She has previous experience with bottle feeding. These two factors will increase the likelihood of successful teaching-learning. The physical environment is not addressed in the root of the question. The nurse is experienced in teaching new mothers about bottle feeding.To administer an IM injection safely to a 6-year-old, the nurse must be aware of the child's developmental stage. This knowledge will assist the nurse in gaining the child's cooperation prior to the treatment. During this process, the nurse is functioning in the role of
a. teacher
b. care provider
c. manager
d. advocateb. care provider
The care provider provides direct nursing care. The role includes understanding developmental stages and appropriately altering care to meet the patient's needs. In the role of teacher, patient education is the priority. In the role of advocate, the nurse will speak on behalf of the patient to express the patient's wishes and needs. In the role of manager, the nurse coordinates care of the patient.A 54-year-old woman is experiencing symptoms of a urinary tract infection and needs to seek health care. Which advanced practice nurse would be the best choice for this woman?
a. clinical nurse specialist
b. certified nurse-midwife
c. family nurse practitioner
d. pediatric nurse practitionerc. family nurse practitioner
A family nurse practitioner is prepared to care for people of all ages. They can assess, diagnosis, and treat patients. A certified nurse-midwife provides care during pregnancy, childbirth, and postpartum. A clinical nurse specialist functions as a clinical leader but does not provide primary care. A pediatric nurse practitioner provides primary care to children.A 28-year-old postpartum patient tells the nurse, "I won't be going home for about 2 weeks." To clarify the statement, the nurse may state
a. "Tell me what you mean when you say you won't be going home for 2 weeks."
b. "I know you are excited."
c. "So you will be here with us for 2 more weeks?"
d. "Go on ...."a. "Tell me what you mean when you say you won't be going home for 2 weeks."
To clarify a statement is to ensure understanding and accuracy of the message. The nurse can clarify a message by asking for further specific information.The nurse is admitting a woman to the labor unit. During the admission procedure, the nurse obtains the woman's blood pressure, pulse, respirations, temperature, and fetal heart rate. The nurse is using which part of the nursing process?
a. implementation
b. evaluation
c. planning
d. assessmentd. assessment
The assessment phase of the nursing process is a systematic collection of relevant data. Vital signs are considered patient data. The planning stage includes setting priorities, establishing goals, and planning interventions. The implementation stage is carrying out the plan of care. The evaluation stage is determining if the goals were met.Which nursing interventions are written correctly?
a. Provide 100 mL of fluids of choice every 2 hours while awake.
b. Force fluids.
c. Ambulate daily.
d. Assist with breastfeeding.a. Provide 100 mL of fluids of choice every 2 hours while awake.
Nursing interventions are to be specific. The other examples are not specific. Vague interventions may be confusing and the level of care may be altered.After admitting a new patient to the pediatric unit, the nurse writes a plan of care. This process of determining outcomes and interventions is which stage of the nursing process?
a. evaluation
b. assessment
c. implementation
d. planningd. planning
During the planning stage, the nurse establishes outcomes and writes nursing interventions. Assessment stage involves collecting the patient data. Implementation stage is the active phase; it is carrying out the plan of care. Evaluation stage determines how well the plan worked.A nurse who speaks on behalf of a patient is acting in the role of a(n)
a. collaborator
b. manager of care
c. researcher
d. advocated. advocate
An advocate speaks on behalf of another. The nurse should be aware of the patient's wishes and needs and intercede for the patient. The nurse as a researcher investigates theoretic or practice issues in nursing. The nurse as collaborator works with other team members to coordinate and manage the patient's care. The nurse as manager supervises other health care workers as they provide patient care.When comparing therapeutic communication with social communication, therapeutic communication is
a. mutually satisfying and rewarding.
b. predictable
c. goal-directed and focused.
d. a mutual give and take between the nurse and patient.c. goal-directed and focused.
Therapeutic communication is patient-oriented and goal-directed. The focus is the patient. Social communication provides mutual satisfaction, whereas therapeutic communication focuses on the patient's needs only. Social communication is a mutual give and take, whereas therapeutic communication focuses on the patient's needs only and is not predictable.When a nurse faces a difficult problem, the thinking process should be controlled and directed toward finding solutions or opinions. This form of thinking is termed
a. nursing process.
b. critical thinking.
c. undirected thinking.
d. emotional thinking.b. critical thinking.
Critical thinking is controlled and directed. It includes recognizing assumptions, examining biases, analyzing the need for closure, collecting and analyzing data, and evaluating emotions and environmental factors. Nursing process is a way the nurse can assess the patient, plan care, and determine the success of the care. Undirected thinking is not focused on finding solutions. Emotional thinking deals with the emotional side of an issue and does not focus on the facts.The nurse is assessing a 3-year-old African-American child in the clinic for the first time. The child's height and weight are at the 25th percentile on the commonly used growth chart from the National Center for Health Statistics. How should the nurse interpret these data?
a. The child's growth is within normal limits.
b. The chart is not useful until several measurements are plotted over time.
c. The chart is not accurate for African-American children.
d. The child's growth is not within normal limits.a. The child's growth is within normal limits.
The 25th percentile is within the normal range. Children from different ethnic and racial groups are included in the statistics, making the growth chart representative. The chart is useful both for screening and for assessment over time.The nurse is providing discharge information for a family who recently moved from China and who say they understand English quite well. Which approaches would be best for the nurse to use for effective teaching? (Select all that apply.)
a. Use "yes" and "no" questions for easiest feedback from the family.
b. Speak clearly, but a little louder, so they can understand the language better.
c. Have the family members demonstrate a skill if one will need to be done in the home.
d. Avoid staring at the family members directly in the eye.
e. Have the family members explain what has been said.
f. Address the oldest family member first before beginning any teaching.c, d, e, f
The elders of the family are highly respected and should be addressed initially. Other family members should be encouraged to learn and participate. Even people who have been in the United States for many years often do not feel competent in English. People from Southeast Asia avoid prolonged eye contact, which they consider rude. It is better to glance at their face and eyes periodically. The nurse should avoid "yes" or "no" questions and have the family explain or demonstrate understanding of the teaching provided. Speaking louder does not help someone understand the language better.The nurse is preparing cough medication for several patients of various faiths and realizes that it contains alcohol. For which religious groups is alcohol forbidden, requiring the nurse to check if the patient can consume the medication? (Select all that apply.)
a. Jewish
b. Islam
c. Christian Science
d. Catholic
e. Jehovah's Witnessb, c, e
The nurse would need to check with the patient prior to administration. Patients of the Islamic, Christian Science, and Jehovah's Witness religions do not use alcohol.Members of the Jehovah's Witness faith are opposed to certain aspects of health care: (Select all that apply.)
a. Blood transfusions
b. Birth control
c. Autopsy
d. Infant baptisma, d
Blood transfusions are not allowed. May accept alternatives to transfusions, such as use of non-blood plasma expanders, careful surgical technique to minimize blood loss, and use of autologous transfusions. Jehovah's Witnesses are prepared to die rather than break God's law. Infant baptism is not performed. Adult baptism is done by immersion. Use of birth control is a personal decision. Autopsy will be decided by persons involved.Which term refers to a shared cultural, social, and linguistic heritage?
a. Ethnicity
b. Socialization
c. Beliefs
d. Culturea. Ethnicity
Ethnicity is an affiliation of a set of persons who share a unique cultural, social, religious, and linguistic heritage. Beliefs are attitudes that can be shared, not only within but also across ethnic groups. Culture is a pattern of beliefs and values that are learned and shared from generation to generation and guides the thinking, decisions, and actions of a group of people. Socialization is the process by which individuals learn the roles that are expected of them.Factors that may interfere with the family's ability to provide for the needs of its members include
a. smoking and abuse of other substances.
b. birth of a healthy infant.
c. adequate financial resources.
d. adequate family support.a. smoking and abuse of other substances.
Unhealthy habits such as smoking and abuse of other substances may interfere with family functioning. Other factors include a lack of financial resources, absence of adequate family support, birth of an infant who needs specialized care, an ill child, and inability to make mature decisions that are necessary to provide care for the children.The nurse is caring for a dying boy whose religion is Islam (Muslim/Moslem). What information should the nurse use when considering his religion and impending death?
a. There are specific practices to be followed.
b. The family is expected to wait away from the dying person.
c. Ask the family about organ donation.
d. There are no special rites related to death.a. There are specific practices to be followed.
There are special rites. The nurse should ask the family what should be done, or someone from the person's mosque can be called to assist. Death ritual prescribes the handling of corpse by only family and friends. Burial occurs as soon as possible. Autopsy and organ donation will be opposed by the family.The nurse is planning care for a patient with an ethnic background different from the nurse's. What approach by the nurse is best during the planning?
a. Strive to keep ethnic background from influencing health needs.
b. Adapt the patient's ethnic practices as possible to the patient's health situation.
c. Attempt, in a nonjudgmental way, to change ethnic beliefs.
d. Encourage continuation of ethnic practices in the hospital setting.b. Adapt the patient's ethnic practices as possible to the patient's health situation.
Whenever possible, nursing care should facilitate the integration of ethnic practices into caring for the patient and supporting the patient's health needs. The ethnic background is part of the individual; it would be very difficult to eliminate the influence of the ethnic background. The ethnic practices need to be evaluated within the context of the health care setting to determine whether they are conflicting. The ethnic background is part of the individual; it would be very difficult to eliminate the influence of the ethnic background.The parents of a young child ask the nurse for suggestions on how to discipline. When discussing the use of "timeouts," what approach should the nurse recommend?
a. electing an area that is safe and non-stimulating, such as a hallway.
b. Try another approach if the child cries, refuses, or is more disruptive.
c. Send the child to his or her room if the child has one.
d. Use 5 minutes per year of age for this discipline.a. electing an area that is safe and non-stimulating, such as a hallway.
The area must be non-stimulating and safe. The child becomes bored in this environment and then changes behavior to rejoin activities. The child's room may have toys and other equipment and activities that may negate the effect of being separated from the family activities. In addition, the place where the child sleeps should retain positive association and should not be used as a site of discipline. The general rule is 1 minute per year of age, not 5 minutes per year. When the child engages in such behavior, the child should be reminded that the timeout begins when the child quiets, rather than allowing the child to manipulate his way out of discipline.Families are sometimes categorized into three types: (Select all that apply.)
a. Low risk
b. Traditional
c. High risk
d. Nontraditionalb, c, d
Traditional families (also called nuclear families) are headed by two parents. The growing number of nontraditional families includes single-parent families, blended families, adoptive families, unmarried couples with children, multigenerational families, and homosexual parent families. Examples of high-risk families are those experiencing marital conflict and divorce, those with adolescent parents, those affected by violence against one or more of the family members, those involved with substance abuse, and those with a chronically ill child.A child with a hearing impairment and who reads lips is going to surgery. What strategies would maximize that the child understands what is happening? (Select all that apply.)
a. Use gestures to act out what is happening.
b. Face the child when speaking.
c. Demonstrate what is going to happen whenever appropriate.
d. Speak a little slower than usual.
e. Assure the child is asleep before the surgical masks are pulled up on the staff members' faces.b, c, e
Assuring the child is asleep before the surgical masks are pulled up on the staff members' faces provides the child with the ability to read lips. Once the mask is pulled up, the child can no longer read lips. Facing the child when speaking facilitates communication. Demonstrating what is going to happen whenever appropriate such as checking a temperature or listening to a chest can facilitate cooperation. Speaking a little more slowly than usual can distort the shape of the speaker's mouth and make it harder to understand. Using gestures to act out what is happening may be confusing and frustrating to a young child.A nurse is interviewing the mother of Adam, age 9 years. What is the most appropriate question that the nurse should ask Adam's mother regarding his school performance?
a. How well does Adam seem to be doing in school?
b. Did Adam go to preschool?
c. Does Adam have problems at school?
d. How is Adam doing in school?d. How is Adam doing in school?
How is Adam doing in school? is an open-ended question without any descriptive terms that may limit the mother's responses. Did Adam go to preschool? is a closed-ended question that would elicit a yes/no answer. Does Adam have problems at school? is a closed-ended question that implies that Adam is not doing well. How well does Adam seem to be doing in school? is a closed-ended question that would elicit a short answer and not provide much information. It implies that whatever the mother thinks won't match the facts.When using an interpreter to obtain information during an interview, what should the nurse do at the beginning of the interview?
a. Explain to the interpreter the reason for the interview.
b. Direct the initial questions to the interpreter.
c. Discourage the interpreter and client from discussing topics that will not be included in the interview.
d. Ask several questions at a time to determine the speed of interpretation.a. Explain to the interpreter the reason for the interview.
Explaining the reason for the interview will enable the interpreter to understand the purpose and observe for nonverbal cues. One question at a time should be asked, leaving sufficient time for the family to answer so that important responses are not cut off. When multiple questions are asked, whole segments of communication may be lost. Communication should be made directly with the client and family. Additional discussion will facilitate the interpreter being accepted by the family.A nurse needs to give an injection in the arm of a young child. Using knowledge of child development, what is the most appropriate approach by the nurse?
a. Explain that child will experience "a little stick in the arm."
b. Smile while giving the injection, so that the child knows that you like him or her.
c. Explain using concrete terms, such as "putting medicine under the skin."
d. Smile while giving the injection to help the child relax.c. Explain using concrete terms, such as "putting medicine under the skin."
By using a concrete term, the nurse can help the child understand what the nurse is going to do. Smiling while giving the injection is too abstract. The young child will not connect your smile with a feeling of sufficient safety so as to relax. Indeed, smiling while causing some pain may precipitate the child's dislike and future distrust of the nurse. Distraction techniques would be necessary to put the child at ease. If the nurse tells the child they will experience "a little stick in the arm," the child may imagine an actual stick being placed in the arm. Whether the child likes the nurse is not the issue; proper preparation for a procedure is the important element.A nurse is assigned as the home health nurse for a child who is technology dependent. The nurse recognizes that the background of this family differs widely from the nurse's own. What is the most appropriate approach by the nurse in caring for this child?
a. Assess why the family is different.
b. Change the family's understanding.
c. Determine whether the family is dysfunctional.
d. Respect the differences seen in the family.d. Respect the differences seen in the family.
The nurse must respect the family's culture and background. The family is the constant in the child's life. The nurse may have some influence on care necessary for the child, but it is inappropriate for the nurse to try to change the family. The nurse does need to assess the differences to consider safety for the child, but it is most important to respect these differences as far as is possible within the confines of child safety. It is not the role of the nurse to determine whether the family is dysfunctional unless the child is at risk.What is the most appropriate approach for parents to tell their children about their decision to divorce?
a. Avoid discussing the reason for the divorce.
b. Give reassurance that the divorce will not affect most aspects of the children's lives.
c. Give reassurance that the divorce is not the children's fault.
d. Avoid crying in front of the children.c. Give reassurance that the divorce is not the children's fault.
Parents, if able, should hold and touch children and reassure them that the children are not the cause of the divorce. Parents can cry in front of children; it may give the children permission to do the same. Parents should provide the reasons for the divorce at a level the children will understand. To give reassurance that the divorce will not affect most aspects of the children's lives is to give false reassurance, because many aspects will change.Several nurses tell their nursing supervisor that they want to attend the funeral of a child for whom they had cared. They received approval of their request because the supervisor understands that the funeral serves what purpose?
a. Burnout can be totally eliminated by attendance at the funeral.
b. Families appreciate this expression of concern.
c. It can assist in the resolution of personal grief.
d. It helps prepare the nurses for further deaths.c. It can assist in the resolution of personal grief.
Nurses should attend the funeral of a child if they were close with the family. This will help the nurses grieve and gain closure. Families may or may not expect this expression of concern. Attendance at one child's funeral does not prepare nurses for future deaths. Attending the funeral helps with the grief process and may prevent burnout.The nurse is helping a preschool-age child understand the medicine used to make him sleep during surgery. Which explanation by the nurse would be best?
a. "You'll be put you to sleep."
b. "You will have a needle placed in your hand, and your sleepy medicine will go in through it."
c. "You'll be asleep for a while, and then you'll wake up and come back to your room."
d. "You will get some medicine that will make you sleepy, and you'll sleep during your operation. Then you'll wake up."d. "You will get some medicine that will make you sleepy, and you'll sleep during your operation. Then you'll wake up."
It's important that the child know that medicine will make him sleep and that waking up is included in the explanation. Using the phrase "putting you to sleep" may be what happened to the sick or old pet that never came home. It is not a phrase that should be used with children. A preschool child is afraid of penetrating objects and mutilation and mentioning a needle would make the child frightened. Telling the child "you will come back to your room" might be interpreted as the bedroom at home because of lack of clarity of the explanation.A school-age child with a visual impairment is admitted to the hospital for pneumonia. What is the initial action the nurse should take?
a. Orient the child to the room, bed controls, and machine noises.
b. Explain the schedule of the unit in great detail.
c. Ambulate the child down the hall to the nursing station.
d. Obtain a thorough assessment of the child's self-help skills and abilities.d. Obtain a thorough assessment of the child's self-help skills and abilities.
Assessing the child's self-help skills and abilities provides the health care team with information about the child. Orienting the child to the room, bed controls, and machine noises should be done after the assessment is complete. Explaining the schedule of the unit in great detail and ambulating the sick child down the hall to the nursing station may be overwhelming to the sick child.The sense of touch can convey what feelings? (Select all that apply.)
a. Caring
b. Comfort
c. Warmth
d. Reassurancea, b, c, d
Components of effective communication involve verbal and nonverbal interactions that include touch, physical proximity, environment, listening, eye contact, visual cues, pace of speech, tone of voice, and overall body language.Which statement best explains the growth and development of children?
a. The sequence of developmental milestones is predictable.
b. Development proceeds at a predictable rate.
c. Rates of growth are consistent among children.
d. At times of rapid growth, there is also acceleration of development.a. The sequence of developmental milestones is predictable.
There is a fixed, precise order to child development. There are periods of both accelerated and decelerated growth and development. Each child develops at his or her own rate. Physical growth and development proceed at differing rates.According to Piaget, at what stage of development do children typically solve problems through trial and error?
a. Preoperational
b. Concrete operational
c. Sensorimotor
d. Formal operationalc. Sensorimotor
During the sensorimotor stage, infants and young toddlers develop a sense of cause and effect. Relational problem solving is characteristic of the preoperational stage. In the formal operational stage, adolescents can test hypotheses. Children in concrete operations solve problems in a tangible, systematic fashion.A mother tells the nurse that she will visit her 2-year-old child tomorrow around noon. During the child's bath in the morning, the child asks for her Mommy. What is the best response by the nurse?
a. "Mommy had to go home for a while, but she will be here today."
b. "Mommy always comes back to see you."
c. "Mommy will be here after lunch."
d. "Your Mommy told me yesterday that she would be here today about noon."c. "Mommy will be here after lunch."
Because toddlers have a limited concept of time, the nurse should translate the mother's statement about being back around noon by linking the arrival time to a familiar activity that takes place at that time such as lunch. "Mommy always comes back to see you" doesn't give the child any information about when her mother will visit. "Mommy had to go home for a while, but she will be here today." Doesn't give the child any information about when her mother will visit. Noon is a meaningless concept for a toddler.A mother is concerned about giving her infant the scheduled immunizations. What information should the nurse provide to inform the mother about the risks and benefits of immunizations? (Select all that apply.)
a. "If your child is feverish or sick, we will not give any immunizations at that time."
b. "Fever and local irritation are rare after administration of the DTaP vaccine."
c. "Since live measles vaccine is produced by using chicken eggs, there is a slight chance of hypersensitivity in children with egg allergies."
d. "Before a second dose of any vaccine is given, we check if there were any side effects after the previous dose of that vaccine."
e. "Immunizations are the primary and safest means of managing preventable infectious diseases."
f. "We use the arm muscle for the majority of vaccines in babies."a, c, d, e
Children do not receive immunizations when they are feverish or sick. Live measles vaccine is produced by chick embryo cell culture, so there is a slight chance of hypersensitivity in children with egg allergies. Before a second dose of any vaccine is given, the nurse checks if there were any side effects after the previous dose of that vaccine. Immunizations are the primary and safest means of managing preventable infectious diseases. The thigh muscle is used for vaccines in infants. Fever and local irritation are common after administration of the DTaP vaccine.Which behavior is most characteristic of the concrete operations stage of cognitive development?
a. Progression from reflex activity to imitative behavior
b. Increasingly logical and coherent thought processes
c. Ability to think in abstract terms and draw logical conclusions
d. Inability to put oneself in another's placeb. Increasingly logical and coherent thought processes
Increasingly logical and coherent thought processes are characteristic of concrete operations. Children in this stage are able to classify objects. Inability to put oneself in another's place is characteristic of the preoperational stage (ages 2 to 7 years). Progression from reflex activity to imitative behavior is characteristic of the preoperational stage (ages 2 to 7 years). Adolescents, in the formal operations stage, have the ability to think in abstract terms and draw logical conclusions.Which statement explains why it can be difficult to assess a child's dietary intake?
a. Families usually do not understand much about nutrition.
b. Recall of food consumption is frequently unreliable.
c. Biochemical analysis for assessing nutrition is very expensive.
d. No systematic assessment tool has been developed.b. Recall of food consumption is frequently unreliable.
It is difficult for parents to recall exactly what their child has eaten. Concurrent food diaries are somewhat more reliable. Nutrients for different foods are known; it is the quantity and type of food consumed that is difficult to ascertain. The family does not need nutritional knowledge to describe what the child has eaten. Systematic tools are available.According to Erikson, with which development task is infancy concerned with acquiring?
a. Trust
b. Seperation
c. Industry
d. Initiativea. Trust
The task of infancy is the development of trust. Industry versus inferiority is the developmental task of school-age children. Initiative versus guilt is the developmental task of preschoolers. Separation occurs during the sensorimotor stage as described by Piaget.The development of a 2-year-old child is characterized by
a. tripling the birth weight.
b. dressing oneself with supervision.
c. having a vocabulary of at least 500 words.
d. engaging in parallel play.d. engaging in parallel play.
Two-year-olds typically play alongside each other. A toddler still needs help with clothing at 2 years of age. A vocabulary of 300 words is expected at this age. Usually, the birth weight doubles by 6 months of age and triples by 1 year of age. Between 2 and 3 years of age, the birth weight quadruples.According to Erikson, what is the primary psychosocial task of the preschool period?
a. Intimacy
b. Industry
c. Initiative
d. Identityc. Initiative
Preschoolers focus on developing initiative. The stage is known as initiative versus guilt. Identity is the stage associated with adolescence. Intimacy is an adult stage. Industry is the stage seen in the school-age child.Since the preschoolers' thought process is egocentric and they enjoy learning about their environment, what is the most effective approach for communication with children this age?
a. Play
b. Drawing
c. Speech
d. Actionsa. Play
Play is the child's way to learn to understand and adjust to situations. Language is too abstract to be the most effective communication tool for preschool children. Drawing is not developed at this age. Actions are not effective for communication. Interpreting actions requires a level of abstraction not yet achieved by a preschooler.The parent of a 12-month-old male infant says to the nurse, "He pushes the teaspoon right out of my hand when I feed him. I can't let him feed himself because he makes too much of a mess." What is the most appropriate response by the nurse?
a. "It's important to let make a mess and know it will go away as he gets older."
b. "It's important not to give in to this kind of temper tantrum at this age."
c. "He's at the stage where he is old enough to begin learning how to feed himself."
d. "Maybe you need to try a different type of spoon, one designed for young children."c. "He's at the stage where he is old enough to begin learning how to feed himself."
At 12 months the child should be self-feeding. Because children this age eat primarily finger foods, it is useful to offer the parent suggestions for providing meals which the child can feed himself without much frustration while keeping mess to a minimum.The parents of a 5-month-old girl complain to the nurse that they are exhausted because she still wakes up as often as every 1 to 2 hours during the night. When she awakens, they change her diaper, and her mother nurses her back to sleep. What should the nurse suggest to help them deal with this problem?
a. Leave her a bottle of formula when put into her crib at night.
b. Start putting her to bed while still awake.
c. Put her in the parents' bed to cuddle.
d. Let her cry herself back to sleep.b. Start putting her to bed while still awake.
Placing the infant in the crib or bassinet after cuddling but before the infant is completely asleep facilitates self-consoling behavior. Infants who do not learn to self-console when going to sleep expect the parents to console them should they awaken during the night. Never put the infant in the adults' bed. The parents may roll over on the infant and suffocate her. Besides, having the infant in bed with them would be no guarantee of her staying asleep. The infant needs to be checked on if she awakens crying to make sure she is all right. When the infant is allowed to fall asleep with a bottle containing milk or juice, the carbohydrate-rich solution bathes the teeth for a long period and may cause dental caries.Which best describes colic?
a. It is paroxysmal abdominal pain or cramping manifested by episodes of loud crying.
b. Infants older than 6 months of age experience periods of abdominal pain and crying.
c. It is usually the result of poor or inadequate mothering.
d. The infant experiences periods of abdominal pain that result in weight loss.a. It is paroxysmal abdominal pain or cramping manifested by episodes of loud crying.
Colic is defined as paroxysmal abdominal pain or cramping manifested by episodes of loud crying. There is no identified relationship between colic and inadequate mothering.Most commonly colic occurs in infants under 3 months of age.Which characteristic best describes the fine motor skills of a 5-month-old infant?
a. Has a strong grasp reflex
b. Can build a tower of two cubes
c. Is able to grasp object voluntarily
d. Has a neat pincer graspc. Is able to grasp object voluntarily
Grasping an object is a characteristic appropriate for a 5-month-old infant. Pincer grasp is a characteristic of an 11-month-old infant. Strong grasp reflex is a characteristic of a 1-month-old infant. Building a tower of two cubes is a characteristic of a 15-month-old infant.A parent of an 8-month-old infant tells the nurse that the baby cries and screams whenever the infant is left with the grandparents. The nurse's response is based on which observation?
a. The infant is most likely spoiled.
b. An infant crying and screaming when left with grandparents is an abnormal reaction for this age.
c. The grandparents are not responsive to the infant.
d. An infant crying and screaming when left with grandparents is a normal reaction for this age.d. An infant crying and screaming when left with grandparents is a normal reaction for this age.
The infant is feeling stranger anxiety, which is expected for this age.An infant is expected to be able to say "mama" and "dada" with meaning by what age?
a. 14 months
b. 4 months
c. 6 months
d. 10 monthsd. 10 months
At 10 months, infants say sounds with meaning. At 4 months, consonants are added to infant vocalizations. At 6 months, babbling resembles one-syllable sounds. 14 months is late for the development of sounds with meaning.Which is the most appropriate recommendation for relief of teething pain?
a. Rub the infant's gums with aspirin to relieve inflammation.
b. Apply diluted hydrogen peroxide to gums to relieve irritation.
c. Have the child chew on a warm teething ring to encourage tooth eruption.
d. Give the child a frozen teething ring to relieve inflammation.d. Give the child a frozen teething ring to relieve inflammation.
Cold reduces inflammation and should be used for relief of teething irritation. Home remedies, such as rubbing the gums with whiskey or aspirin, should be discouraged. Hydrogen peroxide should not be used because it is ineffective and can cause tissue damage.The mother of a 3-month-old breastfed infant asks about giving her baby water because it is summer and very warm. What is the most appropriate recommendation by the nurse?
a. Water once or twice a day will make up for losses resulting from environmental temperature.
b. Water should be given if the infant seems to nurse longer than usual.
c. Fluids in addition to breast milk are not needed.
d. Clear juices would be better than water to promote adequate fluid intake.c. Fluids in addition to breast milk are not needed.
Sufficient water is provided in breast milk and in prepared formula during early infancy. Fruit juice should be avoided in infants younger than 6 months of age.Which intervention lowers the risk of sudden infant death syndrome (SIDS)?
a. Putting the infant to sleep in the supine position
b. Having the infant sleep with parents instead of alone in a crib
c. Making sure the infant is kept very warm while sleeping
d. Smoking away from the infanta. Putting the infant to sleep in the supine position
The "Back to Sleep" campaign is given credit for reducing the rate of SIDS in the United States. Maternal smoking increases the risk of SIDS. Overheating increases the risk of SIDS. Co-sleeping increases the risk of SIDS because of accidental rollover deaths.Why are infants particularly vulnerable to acceleration-deceleration head injuries?
a. The scalp has extensive vascularity.
b. The anterior fontanel is not yet closed.
c. Nerve tissue is not well developed.
d. The musculoskeletal support of the head is insufficient.d. The musculoskeletal support of the head is insufficient.
The relatively large head size coupled with insufficient musculoskeletal support increases the risk to infants. Anterior fontanel closure, nerve tissue development, and vascularity of the scalp do not have an effect on this type of injury.Which statement is most characteristic of the motor skills of a 24-month-old child?
a. A toddler is able to grasp small objects but cannot release them at will.
b. A toddler walks alone but falls easily.
c. A toddler's activities begin to produce purposeful results.
d. A toddler's motor skills are fully developed but occur in isolation from the environment.c. A toddler's activities begin to produce purposeful results.
Gross and fine motor mastery occur with other activities. A toddler is able to walk up and down stairs at this age. Grasping small objects but being unable to release them at will is a characteristic of infancy. Interaction with the environment is essential at this age.For a toddler with sleep problems, what should the nurse suggest?
a. Varying the bedtime ritual
b. Using a transitional object
c. Restricting stimulating activities during the day
d. Explaining away fearsb. Using a transitional objectRestricting stimulating activities during the day
A transitional object, such as a stuffed animal or blanket, may help the child ease anxiety and facilitate sleep. A toddler requires stimulating physical activity during the daytime, although such activity just before bed prolongs the transition from wakefulness to sleepiness. A consistent ritual will facilitate sleep and is very important at this age. Verbal explanations that rationalize fears away are not internalized by a child at this age.By what age would the nurse expect that most children would be using sentences of six to eight words?
a. 18 months
b. 3 years
c. 5 years
d. 24 monthsc. 5 years
Children can make sentences of 6 to 8 words at 5 years of age. Most will use all parts of speech and construct sentences of the length an adult would use. At 18 months of age, a child has a vocabulary of only 10 words. A child at 24 months uses 2- to 3-word phrases. A child at 3 years of age uses 3- to 4-word sentences.The nurse is conducting a water-safety program for parents of young children at the pediatrician's office. What water safety information should be included? (Select all that apply.)
a. A tub of water used to bathe the dog can be a water hazard.
b. Children can drown in as little as 4 inches of water.
c. Secure the pool drain with a protective cover.
d. Toilets cause little hazard because of the location of the water.
e. Constant supervision of the child is the best safety mechanism for water safety.
f. Supervise the toddler in the tub regardless of how much water is in the bathtub.a, c, e, f
Supervision of the toddler in the tub is necessary regardless of how much water is in the bathtub. Securing the pool drain with a protective cover helps protect the child from entrapment. A tub of water used to bathe the dog can be a water hazard. Constant supervision of the child is the best safety mechanism for water safety. Children can drown in as little as 1 inch of water. Toilet lids need to remain closed. Toddlers can inadvertently fall headfirst into a toilet or bucket, and they lack the upper-body strength and coordination to remove themselves from submersion.The nurse is discussing toddler development with a parent. Which intervention will best foster the achievement of autonomy in the toddler?
a. Providing opportunities for the toddler to play with other children
b. Helping the toddler learn the difference between right and wrong
c. Encouraging the toddler to do things for self when capable of doing them
d. Helping the toddler complete tasksc. Encouraging the toddler to do things for self when capable of doing them
Toddlers have an increased ability to control their bodies, themselves, and the environment. Autonomy develops when children complete tasks of which they are capable. To successfully achieve autonomy, the toddler needs to have a sense of accomplishment. This does not occur if the parents complete tasks for the toddler. Learning the difference between right and wrong is a concept that is too advanced for toddlers and will not contribute to autonomy. Children at this age engage in parallel play, which will not foster autonomy.A mother tells the nurse that her daughter's favorite toy is a large, empty box in which a stove was packaged. She plays "house" in it with her toddler brother. What information should the nurse tell the mother about this type of play?
a. It is an example of creative play that should be encouraged.
b. It suggests that there are limited family resources.
c. It is suggestive of limited adult supervision.
d. This is unsafe play that should be discouraged.a. It is an example of creative play that should be encouraged.
Creative play should be encouraged. After children create something new, they can then transfer their new knowledge to other situations. As long as the play is supervised, it should be encouraged.Which should the nurse recommend to help a toddler cope with the birth of a new sibling?
a. Explain to the toddler that a new playmate will soon come home.
b. Prepare the toddler for the upcoming changes about 1 to 2 weeks before the birth of the sibling.
c. Discourage the toddler from helping with care of the new sibling.
d. Give the toddler a doll with which he or she can imitate parenting.d. Give the toddler a doll with which he or she can imitate parenting.
The toddler can participate in the activity of caring for a new family member but can have a doll of his or her own to care for. The toddler should be encouraged to participate in accordance with his or her abilities. Telling the toddler a new playmate will soon come home will establish unrealistic expectations. Preparation should begin as soon as changes in the mother's physical appearance and the home setting occur.A parent has a 2-year-old in the clinic for a well-child checkup. Which statement by the parent would indicate to the nurse that the parent needs more instruction regarding accident prevention?
a. "We placed gates at the top and bottom of the basement steps."
b. "We turned the thermostat down on our hot water heater."
c. "We stopped using the car seat now that my child is older."
d. "We locked all the medicines in the bathroom cabinet."c. "We stopped using the car seat now that my child is older."
Locking medicines in a cabinet, turning down the thermostat on the hot water heater, and placing gates at the top and bottom of steps are appropriate actions. A car seat should be used until the child weighs 40 pounds, at approximately 4 years of age. After that point, a booster seat that complies with federal safety guidelines should be used. Seat belts must be used with the booster seat.The parents of a 4-year-old girl are worried because she has an imaginary playmate. What response by the nurse is most appropriate?
a. "Imaginary playmates are abnormal after age 2."
b. "Keep watching, and if the behavior continues, an evaluation may be needed."
c. "I wonder if there is some parent-child conflict happening that you're unaware of."
d. "Imaginary playmates are normal and useful at this age."d. "Imaginary playmates are normal and useful at this age."
Imaginary playmates are a part of normal development at this age. The peak incidence of imaginary playmates occurs at 2 to 3 years of age. These playmates usually are not present once school starts.During a well-child visit, the father of a 4-year-old boy tells the nurse that he is not sure whether his son is ready for kindergarten. The child's birthday is close to the cutoff date and child has not attended preschool. Which is the nurse's best recommendation?
a. Have the child begin kindergarten.
b. Observe a kindergarten class to see if his son would fit in.
c. Have the child get a developmental screening.
d. Postpone kindergarten and have the child go to preschool.c. Have the child get a developmental screening.
A developmental screening will provide the necessary information to help the family determine readiness.Parents of a 10-year-old child are concerned that their child has been recently showing signs of low self-esteem. Which developmental information should the nurse consider when discussing this issue with the parents?
a. Changing self-esteem is difficult after about age 5 years.
b. Transitory periods of lowered self-esteem are expected developmentally.
c. Self-esteem is the objective judgment of one's worthiness.
d. High self-esteem develops when parents show adequate love for the child.b. Transitory periods of lowered self-esteem are expected developmentally.
Self-esteem changes with development. Transient changes are expected, and with positive encouragement and support the changes are only temporary. Self-esteem is based on several components: competence, sense of control, moral worth, and worthiness of love and acceptance.Which is descriptive of the social development of school-age children?
a. The social circle contracts during these years.
b. Children frequently have "best friends."
c. Conforming to the rules is not essential.
d. Identification with peers is minimal.b. Children frequently have "best friends."
Same-sex peers form relationships that encourage sharing of secrets and jokes and coming to each other's aid. Identification with a peer group is an important factor toward gaining independence from families. During these years, the child's world expands from the tight circle of the family to include children and adults at school, at a worship community, and in the community at large. Children learn a body of rules, sayings, and superstitions as they enter the culture of childhood. Rules are important to children because they provide predictability and offer security.How does the onset of the pubertal growth spurt compare in girls and boys?
a. It is about the same in both boys and girls.
b. In boys, it occurs about 1 year before it appears in girls.
c. In girls, it occurs about 1 year before it appears in boys.
d. In girls, it occurs about 3 years before it appears in boys.c. In girls, it occurs about 1 year before it appears in boys.
Average age of onset is 9.5 years for girls and 10.5 years for boys.A 12-year-old child being seen in the clinic has not received the vaccine for the hepatitis B virus (HBV). What recommendation should the nurse make?
a. The three-dose series of HBV vaccine should be started at age 16 years or sooner if the adolescent becomes sexually active.
b. One dose of HBV vaccine is needed at age 14 years.
c. Only one dose of HBV vaccine will be needed sometime during adolescence.
d. The three-dose series of HBV vaccine should be started.d. The three-dose series of HBV vaccine should be started.
Adolescents should be vaccinated against hepatitis B at this age if it has not been done previously. Three doses are necessary to achieve immunity. The recommendation is that the hepatitis B vaccine series be started at birth. The American Academy of Pediatrics recommends vaccination by age 13 years.Factors that can lead to malocclusion, a condition in which the teeth are crowded, crooked, or out of alignment include all of the following except
a. premature loss of primary teeth.
b. cleft palate.
c. pacifier use or thumb sucking.
d. heredity.c. pacifier use or thumb sucking.
Pacifier use or thumb sucking is not believed to cause malocclusion unless it persists past age 2 to 4 years; because of the risk, children should stop using the pacifier before their permanent teeth erupt.The nurse is reviewing with a group of parents about what to expect regarding their school-age children. What information should the nurse include? (Select all that apply.)
a. Children this age like to collect groups of things like coins.
b. The developmental task for this age is initiative.
c. Parents and teachers have no influence on moral development
d. The average increase in height is 2 in. per year.
e. The average weight gain is 7 lb per year.
f. Children this age are able to understand sports and social rules.a, d, f
The average increase in height is 2 in. per year. Children this age like to collect groups of things like coins. Children this age engage in recreational sports and are able to understand rules. The average weight gain is 5½ lb per year. Parents and teachers profoundly influence moral development. The developmental task for this age is industry.Which is an important consideration related to childhood stress?
a. Some children are more vulnerable to stress than others.
b. Children do not have coping strategies.
c. Children should be protected from stress.
d. Parents cannot prepare children for stress.a. Some children are more vulnerable to stress than others.
Children's age, temperament, life situation, and state of health affect their vulnerability, reactions, and ability to handle stress. Children can be taught coping strategies. Supportive interpersonal relationships are essential to the psychological well-being of children.The parents of an 8-year-old girl tell the nurse that their daughter wants to join a soccer team. What guidance would be appropriate for the nurse to share with the parents?
a. Girls should compete only against girls because at this age boys are larger and have more muscle mass.
b. Competition is detrimental to the establishment of a positive self-image.
c. Organized sports, such as soccer, are not appropriate at this age.
d. Sports participation is encouraged if the sport is appropriate to the child's abilities.d. Sports participation is encouraged if the sport is appropriate to the child's abilities.
The parents should help the child select a sport that is suitable to her capabilities and interests. Organized sports can provide safe, appropriate activities with supportive parents and coaches. School-age children enjoy competition. Parents and coaches need to recognize the child's abilities and teach proper techniques so the child can compete safely. Increased muscle mass in boys occurs at puberty. Before that, boys and girls can compete on the same teams.What nursing intervention to promote health during middle childhood would be appropriate?
a. Stress the need for increased calorie intake to meet increased demands.
b. Reinforce the need for good dental hygiene because these are the years in which permanent teeth erupt.
c. Instruct parents to defer questions about sex until the child reaches adolescence.
d. Advise parents that the child will need decreasing amounts of rest toward the end of this period.b. Reinforce the need for good dental hygiene because these are the years in which permanent teeth erupt.
Dental care is increasingly important as the primary teeth are replaced by permanent teeth. Malocclusion is not unusual in children of this age. A balanced diet is important to prepare for the adolescent growth spurt. Because of the earlier onset of puberty, sex education programs should be introduced in elementary school. Parents should approach sex education with a life span approach and respond to a child's questions with an answer appropriate to the child's age. School-age children often need to be reminded to go to sleep.Which is an important consideration in preventing injuries during middle childhood?
a. Most injuries are unintentional in this age group.
b. Injuries from burns occur with the highest frequency at this age because of the fascination with fire.
c. Peer pressure is not strong enough to affect risk-taking behavior.
d. Lack of muscular coordination and control results in an increased incidence of injuries.a. Most injuries are unintentional in this age group.
Unintentional injury is the leading cause of death in children of every age-group beyond 1 year of age. Aside from injury from falls, the leading causes of nonfatal unintentional injury in children of this age-group include being struck by or striking an object that resulted in injury, overexertion, lacerations, bites and stings, bicycle injury, and motor vehicle passenger injuries. Peer pressure is significant in this age group. School-age children have more refined muscle development.The school nurse is discussing dental health with children in first grade. Which information should the nurse include in the presentation?
a. Teach the children how to floss teeth properly.
b. Diet has no effect on preventing cavities.
c. Recommend using non-fluoridated toothpaste approved by the American Dental Association.
d. Emphasize the importance of brushing before bedtime.d. Emphasize the importance of brushing before bedtime.
Children should be taught to brush their teeth after meals and before bedtime. Parents should help with flossing until children develop the dexterity required, which occurs at about the time of third grade. Proper brushing and flossing and a well-balanced diet promote healthy gums and prevent cavities. Sugary or sticky between-meal snacks should be limited. The American Dental Association recommends fluoridated toothpaste for this age group.What change in boys indicates the onset of puberty?
a. An increasing penis size
b. Testicular enlargement
c. Growth of dark pubic hair
d. Voice changesb. Testicular enlargement
Testicular enlargement is the first change that signals puberty in boys; it usually occurs between the ages of 9 and 14 years during Tanner stage 2 development. Voice change occurs between Tanner stages 3 and 4. Fine pubic hair may occur at the base of the penis; darker hair and increasing penis size occurs during Tanner stage 3.The nurse observes that a 13-year-old male has gynecomastia (breast enlargement). How should the nurse explain this to this adolescent?
a. It is a normal occurrence during puberty.
b. It is a sign of hormonal imbalance.
c. It denotes there is too much body fat.
d. It is caused by dietary fat intake.a. It is a normal occurrence during puberty.
Gynecomastia is common during mid-puberty in about one third of boys. For most, the breast enlargement disappears within several years. Although gynecomastia may occur in overweight children, in children of normal body weight it is a normal occurrence. It is not related to diet or hormones.Several adolescents approach the school nurse with questions about skin enhancement including tanning, body piercing, and tattoos. Which responses by the nurse contain correct information? (Select all that apply.)
a. Tattoos made with red and green dyes are the easiest to remove if the person wants them removed.
b. Generally, body piercing is harmless, but these procedures must be done under sterile conditions or there can be complications, such as bleeding, infection, keloid formation, and allergies to metal.
c. There are risks of bloodborne infections, skin infections, and allergic reactions to dyes used in the tattoo process.
d. Since many of the tattoo inks contain metal, such as iron, an adolescent needing magnetic resonance imaging (MRI) must inform the MRI center about the tattoo prior to the procedure.
e. Piercing guns are a great way of easy body piercing with minimal infection.
f. Skin cancer occurs very rarely with the use of tanning booths.b, c, d
It is true that generally body piercing is harmless, but these procedures must be done under sterile conditions or there can be complications, such as bleeding, infection, keloid formation, and allergies to metal. It is true that bloodborne infections, skin infections, and allergic reactions to dyes can occur as a result of the tattoo process. It is true that since many of the tattoo inks contain metal, such as iron, an adolescent needing magnetic resonance imaging (MRI) must inform the MRI center about the tattoo prior to the procedure. Piercing guns can cause infection unless all parts that touch the skin are sterile. Tattoos made with red and green dyes are the hardest to remove if the person wants them removed. Skin cancer of all kinds can occur as a result of using tanning booths years later. Many individuals using tanning booths do not use sunscreen and therefore have a higher ultraviolet exposure and look at the short-term glow of the skin rather than thinking of consequences years later.While caring for hospitalized adolescents, the nurse observes that sometimes they are skeptical of their parents' religious beliefs/practices. How should the nurse interpret this behavior?
a. It is abnormal in spiritual development.
b. It is normal in spiritual development.
c. It is related to illness and occurs only at times of crisis.
d. It is related to the inability of parents to explain adequately their beliefs/practices.b. It is normal in spiritual development.
Skepticism describes stage 4 in spiritual development. Adolescents attempt to determine which of their parental standards and beliefs to incorporate into their own. Such skepticism is a normal response for adolescents, unrelated to illness, crisis, or parental communication ability.A parent tells the nurse, "I am worried about my 13-year-old son. He hasn't started puberty, and my daughter did when she was 11 years of age." How can the nurse explain the difference to the parent?
a. This is abnormal because the onset of pubescence is usually earlier in boys than it is in girls.
b. This is normal because the onset of pubescence is usually earlier in girls than it is in boys.
c. This is unusual because the onset of pubescence is usually the same in siblings.
d. That this is unusual and requires further evaluation of the son.b. This is normal because the onset of pubescence is usually earlier in girls than it is in boys.
Girls begin puberty an average of approximately 2 years before boys. The average age of onset for puberty in boys is 12 years. In boys, puberty is considered delayed if testicular enlargement or pubic hair development has not occurred by age 14 years.The school nurse overhears a group of adolescent girls talking about gaining weight and getting fat deposits during puberty. What anticipatory advice would be appropriate for the nurse to give to the girls?
a. Encourage a low-fat diet to prevent fat deposition.
b. Provide reassurance that these changes are normal.
c. Recommend increased exercise to control weight gain.
d. Suggest dietary measures to control weight gain.b. Provide reassurance that these changes are normal.
Muscle mass increases in boys, and fat deposits increase in girls. Ultimately, diet, exercise, and hereditary factors influence adolescents' height, weight, and body build. A healthy balance must be achieved between expected healthy weight gain and obesity. Dietary measures to control weight gain or a recommendation for increased exercise would not be given unless weight gain was excessive.Which is most descriptive of the spiritual development of the older adolescent?
a. The beliefs become more abstract.
b. Emphasis is placed on external manifestations, such as whether a person goes to church.
c. Strict observance of religious customs is common.
d. Rituals and practices become increasingly important.a. The beliefs become more abstract.
Because of their abstract thinking abilities, adolescents are able to interpret analogies and symbols. Strict observance of religious customs, rituals, and practices become less important as the adolescent questions values and ideals of families. Adolescents question external manifestations when not supported by adherence to supportive behaviors.A 16-year-old girl tells the school nurse that she has not started to menstruate yet. The onset of secondary sexual characteristics occurred in this girl about 3 years ago. The appropriate action by the nurse is to
a. refer the adolescent for an evaluation.
b. assume that the adolescent is pregnant.
c. suggest that the adolescent stop exercising until menarche occurs.
d. explain that this is not unusual.a. refer the adolescent for an evaluation.
The establishment of menstruation (menarche) usually occurs between ages 9 and 15 years and should be evaluated. Menstruation usually begins approximately 2 years after the beginning of secondary sexual characteristics. Although pregnancy and excessive exercising are possibilities, further assessment is warranted.A sexually active adolescent asks the school nurse about prevention of sexually transmitted diseases (STDs). What is the most appropriate recommendation by the nurse?
a. Abstain from sex.
b. Any type of contraception method will prevent STDs.
c. The withdrawal method of contraception will prevent STDs.
d. Use condoms.d. Use condoms.
Condoms provide the best available barrier to the organisms that cause STDs. Complete protection from pregnancy and STDs is achievable only through sexual abstinence. However, the adolescent is sexually active and the nurse needs to be open, forthright, and respectful of the decisions she made about sexual activity.A very depressed adolescent tells the school nurse: "I just don't know how I'm going to cope with everything I'm going through—maybe it would be better if I wasn't around anymore." What approach is most important for the nurse to use when working with this student?
a. Recognize he is exhibiting warning signs of suicide.
b. Recognize that what he is saying is an impulsive act resulting from a temporary crisis.
c. Explain that a suicide attempt is an immature way of dealing with stress.
d. Ignore what he is saying—he is only trying to get attention.a. Recognize he is exhibiting warning signs of suicide.
It is imperative that the nurse recognize warning signs of a potential suicide. All threats must be taken seriously. For the depressed young person, suicide may appear to be the only way out. To tell the adolescent that his or her attempt is immature is a certain block to further therapeutic communication. Even if the crisis is temporary, the adolescent's perception may still be that suicide is the only way out. Remember that adolescents are focused on the here and now.When doing genetic counseling with a pregnant woman, the nurse will need to do additional teaching if the patient states
a. "Since both my husband and I carry the gene for cystic fibrosis, my baby has a 50% chance of also being a carrier for the gene."
b. "Both my husband and I are B blood type, so our baby will have to be B type also."
c. "My husband is color blind; if we have a little girl, she probably will not be affected, but if I have a little boy, he may be affected."
d. "Because my husband and I are not Jewish or French-Canadian, the chance that our baby has Tay-Sachs is less."b. "Both my husband and I are B blood type, so our baby will have to be B type also."
B blood type is dominant; however, both parents may have an "O" recessive gene that can be passed on to a child. Families of Jewish descent, French-Canadians, and those with roots in Eastern Europe have a higher incident of Tay-Sachs. Color blindness is an X-linked recessive disorder; girls tend to be carriers, and boys will develop the problem. Cystic fibrosis is an autosomal recessive disorder, so if both parents are carriers, then there is a 50% chance that an offspring will be a carrier.A woman is in active labor and about to deliver a baby girl (diagnosed by ultrasound). The woman's husband has hemophilia A. The nursery nurse planning to care for the infant needs to be aware that she
a. will have a 50% chance of being a carrier but will not have the disorder.
b. will be a hemophilic and therefore must be prepared for bleeding problems.
c. will neither be a carrier nor have the disorder.
d. will be a carrier.d. will be a carrier.
Hemophilia is an X-linked recessive disorder. The father will pass the disorder to 100% of their daughters, and the daughters will become carriers.In planning care for a new patient in the prenatal clinic, the nurse is aware that various test are available to screen for fetal abnormalities. One that is used early in pregnancy is
a. chorionic villus sampling.
b. testing fetal blood for metabolic disorders.
c. maternal blood test for folic acid levels.
d. maternal complete blood cell count.a. chorionic villus sampling.
Chorionic villus sampling is done in the first trimester. The chromosomes will be analyzed for fetal abnormalities. Folic acid intake is extremely important early in the pregnancy to prevent fetal abnormalities. However, blood testing for folic acid levels and CBC will not screen for fetal abnormalities. Testing for metabolic disorders is done on the newborn.During teaching to an antepartum patient, it is important for the nurse to give information about ways to avoid some birth defects. One area of concern that can be taught at this time is
a. lifestyle changes.
b. the need for adequate exercise.
c. the need for genetic counseling.
d. the importance of keeping all of her prenatal appointments.a. lifestyle changes.
Lifestyle changes such as stopping alcohol consumption, stopping smoking, and avoiding chemicals and medications that are teratogenic can prevent some birth defects. Genetic counseling should be done prior to pregnancy. Adequate exercise and prenatal check-ups are important for a healthy outcome of a pregnancy but are not associated with birth defects.When assisting with the collection of a specimen for chromosome analysis, the nurse must
a. place the collection tubes on ice immediately.
b. ensure that the cells in the specimen stay alive.
c. observe the length of time required for clot formation.
d. provide collection tubes that have no preservatives.b. ensure that the cells in the specimen stay alive.
Specimens for chromosome analysis must contain living cells, because chromosomes are visible microscopically only in living dividing cells.Environmental substances known or thought to harm the fetus include (Select all that apply.)
a. Zika infection.
b. toxoplasmosis infection.
c. flu virus.
d. penicillin.
e. cocaine.
f. tetracycline.a, b, e, f
Cocaine use, infections with toxoplasmosis and Zika, and tetracycline use during pregnancy are known or thought to harm the fetus. Penicillin and the flu virus are not.A 39-year-old is seeing the nurse-midwife for her first prenatal visit. The pregnancy was a surprise—"I thought I was going through the change of life." This is her first pregnancy, and she has no previous health problems. She does not smoke and drank one alcoholic beverage a week until she discovered she was pregnant. Which part of the woman's history shows the highest risk for the fetus developing a chromosomal abnormality such as trisomy 21 and therefore alerts the nurse-midwife to discuss doing genetic studies on the fetus?
a. The fact that the woman is 39 years old
b. Chances that the woman is perimenopausal
c. No preplanning for the pregnancy
d. Drinking alcohol (one drink a week) during early pregnancya. The fact that the woman is 39 years old
Maternal age greater than 35 is the highest risk factor for chromosomal abnormalities such as trisomy 21. The low alcohol intake and not planning for the pregnancy are not risk factors for this disorder. The perimenopausal state does not increase the risk of trisomy 21, unless it is related to being more than 35 years old.A woman is admitted to the labor unit in active labor. She informs the nurse that she has had no prenatal care. She has been taking Fioricet (acetaminophen, butalbital, caffeine) for pain throughout the pregnancy. The nurse is aware that this drug is classified as X and therefore
a. is a teratogen and the fetus may be harmed.
b. information is not sufficient to determine if the fetus will be harmed.
c. will not harm the fetus.
d. will only affect one fetal organ system.a. is a teratogen and the fetus may be harmed.
A class X medication means that the drug is well established as being harmful to a fetus and should not be used during pregnancy. Class A drugs have no demonstrated fetal risk. Class B and C drugs suggest possible harm, but no studies have been done on humans to prove safety. Teratogens typically cause more than one defect.The nursery nurse is called in to the delivery room of a 22-year-old primigravida. The delivery nurse informs the nursery nurse that the patient had oligohydramnios throughout the pregnancy. In planning care for the newborn, the nursery nurse is aware that the baby may develop
a. low blood sugar.
b. jaundice.
c. there are no potential problems associated with oligohydramnios.
d. respiratory problems.d. respiratory problems.
Prolonged oligohydramnios interferes with fetal lung development. Therefore, the nurse needs to assess for respiratory problems. Other potential problems include fibrous amniotic bands that can result in fetal deformations or intrauterine limb amputation. Low blood sugar and jaundice are not associated with oligohydramnios.People who have two copies of the same abnormal autosomal dominant gene will usually be
a. infertile and unable to transmit the gene.
b. mildly affected with the disorder.
c. more severely affected by the disorder than people with one copy of the gene.
d. carriers of the trait but not affected with the disorder.c. more severely affected by the disorder than people with one copy of the gene.
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. Having two copies of the same abnormal autosomal dominant gene does not always lead to infertility. Therefore, the individual may be able to transmit the gene. Because the gene is dominant, the individual will manifest the disorder and not just be a carrier.