Test Bank For Essentials of Pediatric Nursing, 3th Edition

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Page 1Origin: Chapter 1, 11.The nurse providing family-centered care in a hospital setting reflects on the focus ofthe health care provided in today's society. Which statementbestdescribes the currentdefinition of health?A)Health is described as 'an absence of disease.'B)Health is measured by monitoring mortality and morbidity of a group.C)Health is a state of complete physical, mental, and social well-being.D)Technological gains made in health care are shared equally among all children.Ans:CFeedback:In the past, health was defined simply as the absence of disease; health was measured bymonitoring the mortality and morbidity of a group. Over the past century, however, thefocus of health has shifted to disease prevention, health promotion, and wellness. TheWorld Health Organization (2013) defines health as "a state of complete physical,mental, and social well-being, and not merely the absence of disease or infirmity." Thegains in child health have been huge, but, unfortunately, these gains are not sharedequally among all children.Origin: Chapter 1, 22.The student nurse is learning about the past history of child health and health care in theUnited States. Which statement accurately reflects the condition of health care in thepast and current centuries?A)In past centuries in the United States, the health of the country was better than it istoday due to the simpler style of living.B)In the current century, mortality rates are high, but life expectancy has increaseddue to technological advances.C)In the late eighteenth and early nineteenth centuries urban public healthimprovements made cities healthier places for growing children.D)By the late twentieth century unintentional injuries rather than infectious diseaseshad become the leading cause of death for children older than 1 year old.Ans:DFeedback:In past centuries in the United States, the health of the country was poorer than it istoday; mortality rates were high and life expectancy was short. Over the years the healthof children received more and more attention, leading to a better understanding ofsources of illness and improvements in sanitation, water, and nutrition. As a result, bythe late twentieth century unintentional injuries rather than infectious diseases hadbecome the leading cause of death for children older than 1 year old.

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Page 2Origin: Chapter 1, 33.The nurse is administering a number of therapeutic interventions for neonates, infants,and children on the pediatric unit. Which intervention contributes to an increase inchronic illness seen in early childhood?A)Administering antibiotics to prevent lethal infectionsB)Vaccinating children to prevent childhood diseasesC)Using mechanical ventilation for premature infantsD)Using corticosteroids as a treatment for asthmaAns:CFeedback:Using mechanical ventilation and medications to foster lung development in prematureinfants increases their survival rate. Yet the infants who survive are often faced withmyriad chronic illnesses. Administering antibiotics to prevent lethal infections,vaccinating children to prevent childhood diseases, and using corticosteroids as atreatment for asthma may cause side effects, but do not contribute to chronic illness inchildren.Origin: Chapter 1, 44.The nurse is reviewing a copy of the U.S. Surgeon General's Report,Healthy People.Which nursing actionbestreflects the nurse fostering this health care agenda?A)The nurse signs up for classes to obtain an advanced degree in nursingB)The nurse volunteers at a local health care clinic providing free vaccinations forlow-income populationsC)The nurse performs an in-service on basic hospital equipment for student nursesD)The nurse compiles nursing articles on evidence-based practices in nursing topresent at a hospital training seminarAns:BFeedback:Healthy Peopleis a comprehensive health promotion and disease prevention agenda thatis working toward improving the quantity and quality of life for all Americans (U.S.Department of Health and Human Services, 2010). Overarching goals are to eliminatepreventable disease, disability, injury, and premature death; achieve health equity,eliminate disparities, and improve the health of all groups; create physical and socialenvironments that promote good health; and promote healthy development andbehaviors across every stage of life. Volunteering at a local health care clinic directlyreflects the goal of improving the health of all groups of people. Signing up for classes,performing in-services on equipment, and compiling nursing articles on evidence-basedpractices in nursing are all worthwhile activities that foster health care delivery, but arenot as directly linked to the agenda of promoting health in the community.

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Page 3Origin: Chapter 1, 55.The neonatal nurse researches the neonatal and mortality rates in the United States.Which statements accurately describe these measurements of child health? Select allthat apply.A)Neonatal mortality is the number of infant deaths occurring in the first 28 days oflife per 1,000 live births.B)The infant mortality rate refers to the number of deaths occurring in the first 6months of life.C)Neonatal mortality is documented as the number of deaths in relation to 1,000 livebirths.D)The infant mortality rate is used as an index of the general health of a country.E)In 2007, the infant mortality rate in the United States was 6.8 per 1,000 live births.F)The infant mortality rate is consistent from state to state as well as between ethnicgroups.Ans:A, C, D, EFeedback:Neonatal mortality is the number of infant deaths occurring in the first 28 days of lifeper 1,000 live births. The infant mortality rate refers to the number of deaths occurringin the first 12 months of life and is documented as the number of deaths in relation to1,000 live births. The infant mortality rate is used as an index of the general health of acountry; generally, this statistic is one of the most significant measures of children'shealth. In 2007, the infant mortality rate in the United States was 6.8 per 1,000 livebirths. The infant mortality rate varies greatly from state to state as well as betweenethnic groups.

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Page 4Origin: Chapter 1, 66.The nurse researcher investigates the morbidity rate in the United States. Whichstatement accurately reflects this concept?A)Morbidity measures the prevalence of a specific illness in a population at aparticular time.B)Morbidity is presented in rates per 100,000 population.C)Morbidity statistics are revised more frequently because of the ease in defining orobtaining the information.D)In general, 76% of children in the United States enjoyed excellent health and 27%had very good health in a 2007 report.Ans:AFeedback:Morbidity is the measure of prevalence of a specific illness in a population at aparticular time. It is presented in rates per 1,000 population. Morbidity is often difficultto define and record because the definitions used vary widely. For example, morbiditymay be defined as visits to the physician or diagnosis for hospital admission. Also, datamay be difficult to obtain. Morbidity statistics are revised less frequently because of thedifficulty in defining or obtaining the information. In general, 56% of children in theUnited States enjoyed excellent health and 27% had very good health as reported in asummary of health statistics for children in 2007.Origin: Chapter 1, 77.When assessing a family for barriers to health care, the nurse documents checks forpsychosocial barriers. What is an example of this type of health care deficit?A)Academic difficultiesB)Respiratory illnessC)Poor sanitationD)Inherited diseasesAns:AFeedback:Environmental and psychosocial factors are now an identified area of concern inchildren. They include academic differences, complex psychiatric disorders, self-harmand harm to others, use of firearms, hostility at school, substance abuse, HIV/AIDS, andadverse effects of the media. Respiratory illness and inherited diseases are healthproblems, and poor sanitation is an environmental factor.

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Page 5Origin: Chapter 1, 88.When integrating the principles of family-centered care, the nurse would include whichconcept?A)Parents want nurses to make decisions about their child's treatment.B)Families are unable to make informed choices.C)People have taken increased responsibility for their own health.D)Families require little information to make appropriate decisions.Ans:CFeedback:Due to the influence of managed care, the focus on prevention, better education, andtechnological advances, people have taken increased responsibility for their own health.Parents now want information about their child's illness, to participate in makingdecisions about treatment, and to accompany their children to all health care situations.Origin: Chapter 1, 99.The nurse is caring for a 2-week-old girl with a metabolic disorder. Which activitywould deviate from the characteristics of family-centered care?A)Softening unpleasant information or prognosesB)Evaluating and changing the nursing plan of careC)Collaborating with the child and family as equalsD)Showing respect for the family's beliefs and wishesAns:AFeedback:Family-centered care requires that the nurse provide open and honest information to thechild and family. It is inappropriate to soften unpleasant information or prognoses.Evaluating and changing the nursing plan of care to fit the needs of the child and family,collaborating with them as equals, and showing respect for their beliefs and wishes areguidelines for family-centered care.Origin: Chapter 1, 1010.The nurse is caring for a 14-year-old girl with multiple health problems. Which of thefollowing activities wouldbestreflect evidence-based practice by the nurse?A)Following blood pressure monitoring recommendationsB)Determining how often the vital signs are monitoredC)Using hospital protocol for ordering diagnostic testsD)Deciding the prescribed medication doseAns:AFeedback:Using hospital protocol for ordering a diagnostic test, determining how often the vitalsigns are monitored, and deciding the medication dose ordered would be the physician'sresponsibility. However, following blood pressure monitoring recommendations wouldbe part of evidence-based practice reflected in the nursing care delivered.

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Page 6Origin: Chapter 1, 1111.The nurse is caring for a 10-year-old boy with a neuroblastoma. Which activitiesbestdescribe the role of the nurse as a care coordinator, collaborator, and consultant? Selectall that apply.A)Collaborating with the family throughout the care pathB)Advancing the interests of children and their families by knowing their needsC)Informing children and families of their rights and optionsD)Coordinating care provided by the interdisciplinary teamE)Ensuring that the child's and family's needs are met through activities such assupport groupsF)Providing appropriate client education based on the child's developmental levelAns:A, D, EFeedback:The pediatric nurse serves as a collaborator, care coordinator, and consultant.Collaborating with the interdisciplinary health care team, the pediatric nurse integratesthe child's and family's needs into a coordinated plan of care. In the role of consultant,the pediatric nurse ensures that the child's and family's needs are met through suchactivities as support group facilitation or working with the school nurse to plan thechild's care. In the role as a child and family advocate, the nurse safeguards andadvances the interests of children and their families by knowing their needs andresources, informing them of their rights and options, and assisting them to makeinformed decisions. In the role of educator, the nurse instructs and counsels children andtheir families about all aspects of health and illness. In this role the pediatric nurse alsoensures that communication with the child and family is based on the child's age anddevelopmental level.

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Page 7Origin: Chapter 1, 1212.The pediatric nurse operates according to the standards of professional performanceaccording to the American Nurses Association (ANA) Scope and Standards of PediatricNursing Practice. Which statements accurately reflect these standards? Select all thatapply.A)The pediatric nurse uses research findings in practice and participates in thegeneration of new knowledge.B)The pediatric nurse plans and delivers safe, effective nursing care regardless ofthe cost and its impact on practice.C)The pediatric nurse acts as an advocate for the hospital staff, physicians, and otherhealth care team members involved in care of the child.D)The pediatric nurse's decisions and actions in all areas of practice are determinedin an ethical manner.E)The pediatric nurse collaborates with the child, family, and physician in providingcare for the child.F)The health care administrators, not the pediatric nurses, are responsible forimproving the quality and effectiveness of pediatric nursing practice.Ans:A, D, EFeedback:According to the ANA Scope and Standards of Pediatric Nursing Practice, the pediatricnurse uses research findings in practice and participates in the generation of newknowledge; considers factors related to safety, effectiveness, cost in planning anddelivering care, and the impact on practice; and is an advocate for the child and family.The pediatric nurse's decisions and actions in all areas of practice are determined in anethical manner. The pediatric nurse collaborates with the child, family, and physician inproviding care for the child, and systematically improves the quality and effectivenessof pediatric nursing practice.Origin: Chapter 1, 1313.The nurse is providing home care for a 6-year-old girl with multiple medical challenges.Which activities are part of the educator role of the nurse? Select all that apply.A)Arranging for a physical therapy sessionB)Teaching parents to administer albuterolC)Reminding a parent to give a full course of antibioticsD)Giving a DTaP vaccination at the proper intervalE)Showing the parents how to perform proper hand hygieneF)Integrating research findings to establish evidence-based practiceAns:B, C, EFeedback:Teaching parents to administer albuterol, reminding a parent to give the full course ofantibiotics, and showing them how to perform proper hand-hygiene involves the role ofthe nurse as an educator. Arranging for a physical therapy session, giving a DTaPvaccination at the proper interval, and integrating research findings to establishevidence-based practice are examples of care management.

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Page 8Origin: Chapter 1, 1414.The nurse is functioning in the primary role to care for a 12-year-old boy withmetastatic cancer in the liver. Which activity is typical of advocacy?A)Instructing parents about proper home careB)Educating the family about choices they haveC)Telling parents about clinical guidelinesD)Teaching the family about types of cancersAns:BFeedback:Educating the family about choices they have regarding therapies for the cancer in thechild's liver is an example of advocacy, in which the nurse advances the interests of thechild and family by informing them of options and assisting them to make informeddecisions. Telling parents about proper home care, clinical guidelines, and the types ofcancers are all done in the primary role of educator.Origin: Chapter 1, 1515.The nurse is providing care for a 9-year-old girl who is medically fragile. Which is anexample of the nursing role of collaboration?A)Informing the team members of the progress of treatmentB)Discussing the child's needs with a school nurseC)Advising the pulmonologist of respiratory symptomsD)Arranging for after-school attendance at a day care facilityAns:AFeedback:Informing team members of the progress of treatment is an act of collaboration.Discussing the child's needs with a school nurse is done in the role of a consultant.Advising the pulmonologist of respiratory symptoms and arranging after-schoolattendance at a day care facility are care coordinator activities.

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Page 9Origin: Chapter 1, 1616.The nurse is providing care to an ill child and his family. Which activity reflects the useof the assessment step of the nursing process when providing care for children?A)Collecting data about the child and familyB)Analyzing data to make judgments about the child's health stateC)Evaluating care provided by the interdisciplinary teamD)Developing a care plan that incorporates child goalsAns:AFeedback:The nursing process is applicable to all health care settings and consists of five steps:assessment, nursing diagnosis, outcome identification and planning, implementation,and outcome evaluation. Collecting data about the child and family occurs in theassessment step of the nursing process. Analyzing data to make judgments about thechild's health state involves nursing diagnosis, evaluating care provided by theinterdisciplinary team is performed in the outcome evaluation, and developing a careplan that incorporates child goals occurs in the planning stage.Origin: Chapter 1, 1717.The nurse is caring for a 14-year-old boy with a growth hormone deficiency. Whichactionbestreflects using the nursing process to provide quality care to children andtheir families?A)Reviewing the effectiveness of interventionsB)Questioning the facility standards for careC)Earning continuing education creditsD)Ensuring reasonable costs for care providedAns:AFeedback:The nursing process is used to care for the child and family during health promotion,maintenance, restoration, and rehabilitation. It is a problem-solving method based on thescientific method that allows nursing care to be planned and implemented in a thorough,organized manner to ensure quality and consistency of care. The nursing process isapplicable to all health care settings and consists of five steps: assessment, nursingdiagnosis, outcome identification and planning, implementation, and outcomeevaluation. Reviewing the effectiveness of interventions is related to outcomeevaluation in the nursing process. Even though the three remaining answer options arevaluable in ensuring quality of care in health care facilities, they do not involve thedirect care of the child and family using the nursing process.

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Page 10Origin: Chapter 1, 1818.The nurse is caring for a newborn infant who has Down syndrome. Which nursingaction reflects the nurse's use of the ethical principle of nonmaleficence?A)The nurse speaks truthfully to the parents regarding their child's prognosis.B)The nurse provides safe, competent nursing care to avoid harming the infant.C)The nurse involves the parents in making health care decisions for their child.D)The nurse fairly allocates resources for caring for newborns in a facility.Ans:BFeedback:Ethics includes the basic principles of autonomy, beneficence, nonmaleficence, justice,veracity, and fidelity. Nonmaleficence means avoiding causing harm, intentionally orunintentionally. One example is providing safe, competent nursing care. Speakingtruthfully to the parents is an example of veracity. Generally, parents have the autonomyto make health care decisions for their child. Justice refers to acting fairly, and alsoinvolves allocating resources fairly.Origin: Chapter 1, 1919.The nurse is caring for a premature infant and his mother who are scheduled fordischarge even though the nurse feels the mother is not emotionally equipped to returnhome. When balancing the ethical components of this dilemma, the nurse identifies theproblem and gathers more information. What would be the nurse's next step in thisprocess?A)Choose a solution based on available dataB)Implement a solution regardless of pros and consC)Weigh the risks against the benefitsD)Evaluate possible outcomes of the situationAns:CFeedback:The pediatric nurse must balance these ethical components when dealing with familiesfrom a variety of cultural and religious backgrounds who are making health caredecisions for their children. The process is as follows: (1) identify the problem, (2)gather information about the problem, (3) weigh the risks against the benefits, (4)choose a solution, (5) implement the solution, and (6) evaluate the outcome of thesituation.

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Page 11Origin: Chapter 1, 2020.A preschool child is scheduled to undergo a diagnostic test. Which action by the nursewould violate a child's bill of health care rights?A)Arranging for her mother to be with herB)Telling the child the test will not hurtC)Assuring the child that the test will be done quicklyD)Introducing the child to the lab techniciansAns:BFeedback:Telling the child the test will not hurt lacks veracity. It is not a lie, but it does not honorthe child's right to be educated honestly about his or her health care. Arranging for themother to be with the child, assuring the child that the test will be done quickly, andintroducing the child to the lab technicians are actions that honor the child's bill ofhealth care rights.Origin: Chapter 1, 2121.The pediatric nurse knows that the children she is treating are considered minors. Whichstatement accurately describes the regulations related to consent for medical treatment?A)Children older than age 16 can provide their own consent for, or refusal of,medical procedures.B)A guardianad litemmay be appointed by the parents to serve to protect the child'sbest interests.C)Parents ultimately are the decision makers regarding medical treatment for theirchildren younger than the age of 18.D)When divorce occurs, the parent with whom the child is living on a daily basiswill be granted custody of the child.Ans:CFeedback:Parents ultimately are the decision makers for their children. Generally, only personsover the age of majority (18 years of age) can legally provide consent for health care.Minors (children younger than 18 years of age) generally require adult guardians to acton their behalf. Biological or adoptive parents are usually considered to be the child'slegal guardian. When divorce occurs, one or both parents may be granted custody of thechild. In certain cases (such as child abuse or neglect, or during foster care), a guardianad litemmay be appointed by the courts. This person generally serves to protect thechild's best interests.

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Page 12Origin: Chapter 1, 2222.The nurse is caring for a 12-year-old child hospitalized for internal injuries following amotor vehicle accident. For which medical treatment would the nurse ensure that aninformed consent is completed beyond the one signed at admission?A)Diagnostic imagingB)Cardiac monitoringC)Blood testingD)Spinal tapAns:DFeedback:Most care given in a health care setting is covered by the initial consent for treatmentsigned when the child becomes a patient at that office or clinic or by the consent totreatment signed upon admission to the hospital or other inpatient facility. Certainprocedures, however, require a specific process of informed consent, including majorand minor surgery; invasive procedures such as lumbar puncture or bone marrowaspiration; treatments placing the child at higher risk, such as chemotherapy or radiationtherapy; procedures or treatments involving research; photography involving children;and applying restraints to children.Origin: Chapter 1, 2323.A child needs a consent form signed for a minor surgical procedure. Which statementaccurately describes the responsibilities of the health care providers when obtaining theconsent?A)The physician is responsible for ensuring that the consent form is completed withsignatures from the parents or legal guardians.B)The physician is responsible for serving as a witness to the signature process.C)The nurse is responsible for informing the child and family about the procedureand obtaining consent.D)The nurse is responsible for determining that the parents or legal guardiansunderstand what they are signing by asking them pertinent questions.Ans:DFeedback:The nurse's responsibility related to informed consent includes the following:determining that the parents or legal guardians understand what they are signing byasking them pertinent questions, ensuring that the consent form is completed withsignatures from the parents or legal guardians, and serving as a witness to the signatureprocess. The physician or advanced practitioner providing or performing the treatmentand/or procedure is responsible for informing the child and family about the procedureand obtaining consent by providing a detailed description of the procedure or treatment,the potential risks and benefits, and alternative methods available.

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Page 13Origin: Chapter 1, 2424.The nurse is caring for a child brought to the emergency department by a babysitter. Thechild needs an emergency appendectomy and the parents cannot be contacted. Whatwould be the nurse'sbestresponse to this situation?A)Have the babysitter sign the consent form even if she does not have signed papersto do so.B)Have the primary care physician for the child sign the consent form.C)Document failed attempts to obtain consent to allow emergency care.D)Delay medical care until the child's next of kin can be contacted.Ans:CFeedback:Health care providers can provide emergency treatment to a child without consent ifthey have made reasonable attempts to contact the child's parent or legal guardian(American Academy of Pediatrics, Committee on Pediatric Emergency Medicine,2007). If the parent is not available, then the person in charge may give consent foremergency treatment if that person has a signed form from the parent or legal guardianallowing him or her to do so. During an emergency situation, a verbal consent via thetelephone may be obtained. In urgent or emergent situations, appropriate medical carenever should be delayed or withheld due to an inability to obtain consent.Origin: Chapter 1, 2525.The nurse knows that the emancipated minor is considered to have the legal capacity ofan adult and may make his or her own health care decisions. Which of the followingchildren would potentially be considered an emancipated minor?A)A minor with financial independence who is living with his parentsB)A minor who is pregnantC)A child older than 13 years of age who asks for emancipationD)A minor who puts his or her medical decisions in writingAns:BFeedback:Emancipation may be considered in any of the following situations, depending on thestate's laws: membership in a branch of the armed services, marriage, court-determinedemancipation, financial independence and living apart from parents, college attendance,pregnancy, mother younger than 18 years of age, and a runaway.

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Page 14Origin: Chapter 1, 2626.After describing the procedure and medical necessity, the nurse asks a 14-year-old childto assent to a skin graft. Which statement accurately describes the requirements for thistype of assent?A)The age of assent occurs at 12 years old.B)It is not necessary to obtain assent from a minor for a procedure.C)A minor can dissent to a procedure but his or her wishes are not binding.D)In some cases, such as cases of significant morbidity or mortality, dissent mayneed to be overridden.Ans:DFeedback:Assent means agreeing to something. In pediatric health care, the term assent refers tothe child's participation in the decision-making process about health care (McCullough& Stein, 2009). In some cases, such as cases of significant morbidity or mortality,dissent may need to be overridden. The age of assent depends on the child'sdevelopmental level, maturity, and psychological state. The converse of assent, dissent(disagreeing with the treatment plan), when given by an adolescent 13 to 17 years ofage, is considered binding in some states.Origin: Chapter 1, 2727.The nurse is helping the family of a terminally ill child to fill out an advance directivesform. Which options are usually determined by this document? Select all that apply.A)Withholding foodB)Withholding waterC)Withholding antibioticsD)"Do notattempt resuscitate" (DNAR) ordersE)Withholding ventilationF)Providing artificial nutritionAns:C, D, E, FFeedback:Advance directives determine the child's and family's wishes should life-sustaining carebecome necessary. After discussion with other family members, friends, and spiritualadvisors, the parents may make the decision to forego life-sustaining medical treatment,either withdrawing treatment or deciding to withhold certain further treatment or opt notto resuscitate in the event of cardiopulmonary arrest. Food and water are not withheld;however, some children may not be able to drink or eat and artificial nutrition may bewithheld.

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Page 15Origin: Chapter 1, 2828.When integrating the principles of family-centered care, the nurse would NOT includewhich of the following?A)Parents want to make decisions about their child's treatment.B)Families can make informed choices.C)People have taken less responsibility for their own health.D)Families require more information to make appropriate decisions.Ans:CFeedback:Due to the influence of managed care, the focus on prevention, better education, andtechnological advances, people have taken increased responsibility for their own health.Parents now want information about their child's illness, they want to participate inmaking decisions about treatment, and they want to accompany their children to allhealth care situations.Origin: Chapter 1, 2929.The school nurse monitors the amount of physical activity children in a local elementaryschool have planned for each day. This data will helpmostin meeting which foundationhealth measure of Healthy People 2020?A)General health statusB)Health-related quality of life and well-beingC)Determinants of healthD)DisparitiesAns:BFeedback:Participation in common activities, which would include physical activity during theschool day, is included in the foundation health measure of Health-related quality of lifeand well-being. The General health status measure includes measures such as physicallyand mentally unhealthy days, life expectancy, and chronic disease prevalence. Biology,genetics, and individual behavior are included in the Determinants of health measure.Race/ethnicity, gender, and geography are measures of Disparities.

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Page 16Origin: Chapter 1, 3030.The nurse is preparing a presentation regarding prevention of the unintentional injuriesof drowning and bicycle accidents resulting in death. The population attending thepresentation are parents of children ages 1 to 14. Which groups of parents would bebestfor the nurse to target when preparing this presentation? Select all that apply.A)American Indian parentsB)Parents of female childrenC)Parents who live in government subsidized housingD)Single parentsE)Asian American parentsAns:A, C, DFeedback:Unintentional injuries are the number one cause of death in children between the ages of1 and 14 in the United States. Risk factors associated with childhood injuries includemale gender, low socioeconomic status, parents who are unmarried or single, poorhousing, and the highest rates of death are seen in American Indian/Alaska Nativeschildren, followed by African American children.Origin: Chapter 1, 3131.The school nurse is reviewing the records of students in an elementary school. Based oncurrent child morbidity rates, which child is the nurse most careful to monitor for daysmissed from school?A)A child with asthmaB)A child with contact dermatitisC)A child with severe hay feverD)A child with food allergiesAns:AFeedback:Morbidity refers to illness present in a specific population at a given time. Asthma is theleading chronic disease in children, affecting 14% of children in the United States; 13%of children suffer from skin allergies, 9% have hay fever, and 6% have food allergies.

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Page 17Origin: Chapter 1, 3232.The nurse in charge of the quality department is reviewing cases regarding HIPAAcompliance. In which cases does the nurse correctly determine that HIPAA standardswere followed? Select all that apply.A)A child is diagnosed with an inner ear infection and follow-up care instructionsare given to the child's aunt, who provides a medical consent form from theparents, who are on vacation.B)The emergency department nurse manager reports the suspicion of abuse to thechild welfare department for a child admitted with suspicious injuries.C)The grandparents of a child ask the nurse on the medical floor when theirgrandchild will be released home to the parents.D)The physician reports the diagnosis of hepatitis C of a 14-year-old, who is abusinginjectable drugs, to the health department.E)The nurse manager tells the superintendent of schools that a high school student isinfected with HIV so that proper precautions can be implemented in the school.Ans:A, B, DFeedback:The Health Insurance Portability and Accountability Act (HIPAA) of 1996 addressessecurity and privacy issues involving health information about individuals. Informationcan be shared with the client's aunt because medical consent has been granted by thelegal parents. An exception to the rule is the requirement to report suspected physical orsexual abuse of a child. In addition, public health laws require reporting certaininfectious diseases, such as hepatitis C. The nurse should not provide information to thegrandparents without written consent from the legal parents or guardian, nor should thenurse discuss a client's health with the school superintendent. This information shouldbe shared only with local health department.

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Page 1Origin: Chapter 2, 11.The nurse is teaching an athletic father how to stimulate his 7-year-old son who has a'slow-to-warm-up' temperament. Which guidance will bemostsuccessful?A)Telling him to read stories to the child about famous athletesB)Suggesting he take the child to watch him play softballC)Urging him to sign the child up for little league footballD)Proposing wrestling with the child and letting him winAns:AFeedback:Reading stories to the child would be less active and more acceptable to the child'stemperament. Proposing to wrestle with the child and letting him win or signing thechild up for little league football would put the child in an uncomfortable situation, aswould attending his father's adult activities.Origin: Chapter 2, 22.The nurse is performing a health assessment of a school-age child. Based on the child'sdevelopmental level, on which problem would the nurse focus more attention?A)InfectionsB)PoisoningsC)Risk-taking behaviorsD)Accidents and injuriesAns:DFeedback:Developmental level has a major impact on the health status of children. Thephysiologic immaturity of an infant's body systems increases the risk for infection.Ingestion of toxic substances and risk of poisoning are major health concerns fortoddlers as they become more mobile and inquisitive. Because preschool- andschool-age children are, generally, very active, they are more prone to injury andaccidents. Adolescents are establishing their identity, which may lead them to separatefrom the family values and traditions for a period of time and attempt to conform totheir peers. This journey may lead to risk-taking behaviors, resulting in injuries or othersituations that may impair their health.

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Page 2Origin: Chapter 2, 33.The nurse is caring for a 2-year-old girl who is wheezing and has difficulty breathing.Which interview question would provide themostuseful information related to thesymptoms of the child?A)Inquiring about child safety in the homeB)Asking about the temperament of the childC)Asking about the child's dietD)Asking the parents if they smoke in the homeAns:DFeedback:Asking the parents if they smoke in the home would provide the most usefulinformation related to the health condition of the child. If they smoke, the nurse couldexplain that they are affecting their child's health and urge them to stop for her sake.Asking about the temperament of the child and inquiring about home safety or dietwould not reveal any useful information related to the respiratory alteration.Origin: Chapter 2, 44.The nurse is assessing the 'resilience' of a 16-year-old boy. Which exemplifies anexternal protective factor that may help to promote resiliency in this child?A)His ability to take control of his own decisionsB)His ability to accept his own limitationsC)His caring relationship with members of his familyD)His knowledge of when to continue or stop with goal achievementAns:CFeedback:The term resilience refers to the qualities that enable an individual to cope withsignificant adverse events or stresses and still function competently (Lietz, 2007).Various internal and external protective factors promote resiliency. External factorsinclude caring relationships with a family member; a positive, safe learning environmentat school (including clubs and social organizations); and positive influences in thecommunity. Internal factors include the person's ability to take control and be proactive,to be responsible for his or her own decisions, to understand and accept his or her ownlimits and abilities, and to be goal directed, knowing when to continue or when to stop.

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Page 3Origin: Chapter 2, 55.The nurse is assessing a family to determine if they have access to adequate health care.Which statement accurately describes how certain families are affected by commonbarriers to health care?A)After a decade of escalation, the percentage of children living in low-incomefamilies has been on the decline since 2000.B)White, non-Hispanic children overall are more likely than African American andHispanic children to be in very good or excellent health.C)The proportion of children between the ages of 6 and 18 who are overweight isdecreasing, but a large increase is occurring in African American females.D)The overall health care plan of working families may improve access to specialtycare but limit access to preventive services.Ans:BFeedback:White, non-Hispanic children overall are more likely than African American andHispanic children to be in very good or excellent health. After a decade of decline, thepercentage of children living in low-income families has been on the rise since 2000. In2005, 39% of children were living in low-income families and 18% were living in poorfamilies (Douglas-Hall & Chau, 2008). The proportion of children between the ages of 6and 18 who are overweight is increasing, but the largest increase is occurring in AfricanAmerican females (ChildStats.gov Forum on Child and Family Statistics, 2010). Theoverall plan may improve access to preventive services but may limit the access tospecialty care, which has a major impact on children with chronic or long-term illnesses.

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Page 4Origin: Chapter 2, 66.The nurse working in a free community clinic knows that access to health care isaffected negatively by lack of health insurance. What accurately describes the effect oflack of insurance on family health? Select all that apply.A)Parents with uninsured children often delay care for their children.B)Parents with uninsured children are less likely to have taken their children to adoctor or dentist in the last 2 years.C)Parents with uninsured children are three times less likely to have a usual place ofcare for their children.D)The percentage of children without health insurance rose slightly from 11.7% in2006 to 13% in 2007.E)Currently, the states have improved enrollment in Medicaid and the StateChildren's Health Insurance Program (SCHIP).F)Despite state efforts to ensure all children, nearly half of children eligible for thesepublic programs are still uninsured.Ans:A, B, E, FFeedback:Parents with uninsured children often delay care for their children, are less likely tohave taken their children to a doctor or dentist in the last 2 years, and are five times lesslikely to have a usual place of care for their children. The percentage of children withouthealth insurance dropped slightly from 11.7% in 2006 to 11% in 2007. (Sherman,Greenstein, & Parrott, 2008). This decrease is attributed to states' ability to improveenrollment in Medicaid and SCHIP. Despite these efforts, nearly half of childrenuninsured are eligible for these public programs. Lack of awareness, difficulty accessingthe programs, uncertainty of how to apply for the programs, discomfort related toreceiving governmental assistance, and fear of jeopardizing the family's immigrationstatus continue to be factors in failure to enroll children in these programs.Origin: Chapter 2, 77.The nurse is assisting low-income families to access health care. The nurse is awarethat, in today's society, thismostaccurately defines the diversity of a modern family.A)A family consists of parents and their offspring living together.B)A family is whatever the child and family say it is.C)A family is two or more people related or unrelated who are living together.D)A family is two or more genetically related persons living together with separateroles.Ans:BFeedback:The family is considered the basic social unit. The U.S. Census Bureau defines a familyas a group of two or more persons related by birth, marriage, or adoption and livingtogether. Traditional definitions of family emphasize the legal ties or geneticrelationships of people living in the same household with specific roles. Given thediversity of families in today's society, however, some believe that family should bedefined as whatever the child and family say it is (Patterson, 1995).

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Page 5Origin: Chapter 2, 88.The nurse caring for families in crisis assesses the affective function of an immigrantfamily consisting of a father, mother, and two school-age children. Based on Friedman'sstructural functional theory, what defines this family component?A)Meeting the love and belonging needs of each memberB)Teaching children how to function and assume adult roles in societyC)Ensuring the family has necessary resources with appropriate allocationD)Involving the provision of physical care to keep the family healthyAns:AFeedback:According to Friedman's structural functional theory, the affective function involvesmeeting the love and belonging needs of each member. Teaching children how tofunction and assume adult roles in society is the socialization and social placementfunction. Ensuring the family has necessary resources with appropriate allocation isrelated to the economic function, and involving the provision of physical care to keepthe family healthy involves the health care function.Origin: Chapter 2, 99.The nurse is counseling a young couple who in 2 months are having their third baby.The nurse uses Von Bertalanffy's general system theory applied to families to analyzethe family structure. Whichbestdescribes the main emphasis of this theory and itsapplication to family dynamics?A)It emphasizes the family as a system with interdependent, interacting parts thatendure over time to ensure the survival, continuity, and growth of its components.B)It emphasizes the social system of family, such as the organization or structure ofthe family and how the structure relates to the function.C)It emphasizes the developmental stages that all families go through, beginningwith marriage; the longitudinal career of the family is also known as the familylife cycle.D)It addresses the way families respond to stress and how the family copes with thestress as a group and how each individual member copes.Ans:AFeedback:Von Bertalanffy emphasizes the family as a system with interdependent, interactingparts that endure over time to ensure the survival, continuity, and growth of itscomponents. Friedman emphasizes the social system of family, such as the organizationor structure of the family and how the structure relates to the function. Duvallemphasizes the developmental stages that all families go through, beginning withmarriage; the longitudinal career of the family is also known as the family life cycle.The family stress theory addresses the way families respond to stress and how thefamily copes with the stress as a group and how each individual member copes.

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Page 6Origin: Chapter 2, 1010.The nurse volunteering at a homeless shelter to assist families with children identifieshomelessness as a risk preventing families from achieving positive outcomes in life.What family theory encompasses this approach to assessing family dynamics?A)Duvall's developmental theoryB)Friedman's structural functional theoryC)Von Bertalanffy's general system theory applied to familiesD)Resiliency model of family stress, adjustment, and adaptationAns:DFeedback:The resiliency model of family stress, adjustment, and adaption identified the elementsof risks and protective factors that aid a family in achieving positive outcomes. Duvall'sdevelopmental theory described eight chronological stages with specific predictabletasks that each family completes. Friedman's structural functional theory identified fivefunctions of families, and Von Bertalanffy's general system theory defined how familiesinteract with, and are influenced by, the members of their family and society.Origin: Chapter 2, 1111.A 10-year-old girl is living with a foster family. Which intervention is thepriorityforthe child in this family structure?A)Determining if the child is being bullied at schoolB)Dealing with mixed expectations of parentsC)Establishing who is the child's actual caretakerD)Performing a comprehensive health assessmentAns:DFeedback:Because the child may have lived with several different families and may not havecomplete medical files, performing a comprehensive health assessment will beimportant. Determining if the child is being bullied at school is not specific to any onefamily structure. Assessing for problems related to mixed expectations of parents iscommon to a blended family. Establishing the identity of the caretaker is necessary witha communal family.

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Page 7Origin: Chapter 2, 1212.A mother confides to the nurse that she is thinking of divorce. Which suggestion by thenurse would help minimize the effects on the child?A)"Tell the child together using appropriate terms."B)"Reassure him that no one loves him more than you."C)"Do special things with him to make up for the divorce."D)"Share your feelings with the child."Ans:AFeedback:Both parents telling the child about the divorce together, using appropriate terms, willminimize the effects on the child. The other responses suggest unacceptable behaviorsfor the mother, such as competing with the spouse and using the child as a confidante.Origin: Chapter 2, 1313.The nurse is caring for a child and family who just moved out of a dangerousneighborhood. Which of the following approaches is appropriate to the family stresstheory?A)Determining who is the decision makerB)Assessing the child's coping abilitiesC)Finding out how a sibling feelsD)Having to explain procedures to a siblingAns:BFeedback:Assessing the child's coping abilities would serve the child and family's needs accordingto the family stress theory. Finding out how a sibling feels responds to the VonBertalanffy general system theory. Having to explain procedures to a sibling who isbeing protective of the child is consistent with the resiliency model. Identifying thedecision maker is a problem common with extended families.Origin: Chapter 2, 1414.The mother of an 8-year-old girl with a broken arm is the nurturer in the family. Whichnursing activity should be focused on her?A)Teaching proper care proceduresB)Dealing with insurance coverageC)Determining success of treatmentD)Transmitting information to family membersAns:AFeedback:The mother would be the best family member to learn proper care procedures. Dealingwith insurance coverage is the responsibility of the family financial person, transmittinginformation to family members is the gatekeeper's duty, and determining success oftreatment would likely fall to the family decision maker.

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Page 8Origin: Chapter 2, 1515.A parent of four children being interviewed by the nurse states: 'Whatever my husbandand I say goes and the kids need to follow our rules without complaining about them.'What type of parenting style does this attitude represent?A)AuthoritativeB)AuthoritarianC)PermissiveD)Rejecting-neglectingAns:BFeedback:Four major parenting styles seen in our society are authoritarian, authoritative,permissive, and rejecting-neglecting. Theauthoritarianparent expects obedience fromthe child and discourages the child from questioning the family's rules. Theauthoritativeor democratic parent shows some respect for the child's opinions.Permissive or laissez-faire parents have little control over the behavior of their children.Rejecting or neglecting parents are indifferent or uninvolved.Origin: Chapter 2, 1616.The nurse is teaching discipline strategies to the parents of a 4-year-old boy. Whichresponse from the parents indicates a need for more teaching?A)"We should remove temptations that lead to bad behavior."B)"We must explain how we expect him to behave."C)"We should let him know he makes us angry with bad behavior."D)"We must praise him for good behavior."Ans:CFeedback:The response "We should let him know he makes us angry with bad behavior" indicatesthe need to restate how it is important to let the child know that it is not him, but ratherhis behavior, that is bad. Removing temptations, setting expectations, and praising goodbehavior are concepts the parents have expressed learning.

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Page 9Origin: Chapter 2, 1717.The nurse is teaching parents of a 2-year-old about the extinction method of discipline.What is an example of this method of discipline?A)Praising the child for good behaviorB)Reprimanding the childC)Spanking the childD)Enforcing a 'time-out'Ans:DFeedback:Extinction focuses on reducing or eliminating the positive reinforcement forinappropriate behavior. Examples are ignoring the temper tantrums of a toddler,withholding or removing privileges, and requiring "time-out." Praising the child forgood behavior is a form of positive reinforcement and reprimanding and spanking thechild are forms of punishment.Origin: Chapter 2, 1818.The nurse is teaching discipline strategies to the parents of a 14-year-old girl. Whichtopic is an example of positive reinforcement discipline?A)Unplugging the DVD player for the weekendB)Taking a chore away from her for a weekC)Having her clean up the kitchen for a weekD)Ignoring her request if she doesn't say "please"Ans:BFeedback:Taking a chore away from the child for a week is an excellent way to reward her forpositive behavior. Unplugging the DVD player, assigning an extra chore, and ignoringher until she uses good manners are not examples of positive reinforcement.

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Page 10Origin: Chapter 2, 1919.The nurse who is scheduled to work in a clinic in a Hispanic neighborhood takes time toresearch Hispanic cultural norms to better provide culturally competent care. Thisbehavior is an example of which cultural component?A)Cultural awarenessB)Cultural knowledgeC)Cultural skillsD)Cultural encounterAns:BFeedback:Cultural knowledge is the acquisition of information about other cultures from a varietyof sources. Cultural awareness is an exploration of one's own culture and how values,beliefs, and behaviors have influenced personal life. Cultural skills and practicesprovide for the incorporation of knowledge of cultural background including specificpractices for health, and a cultural encounter is participation in, and interaction with,persons of diverse cultural backgrounds.Origin: Chapter 2, 2020.The nurse accepts an assignment that involves caring for new parents and their infants ina clinic in a predominantly African American neighborhood. In order to apply culturallycompetent care, the nurse investigates the common beliefs and practices that may affectthe health of these parents and infants. What are some examples of these beliefs? Selectall that apply.A)Strong extended family relationships; mother as head of household; elder familymembers valued and respectedB)Use of complementary modalities with Western health care practicesC)View of health as harmony with nature, illness as disruption in harmonyD)View of pain and suffering as inevitable; relief achieved through prayers andlaying on of handsE)Health viewed as God's will maintainable with a balance of hot and cold foodintakeF)Restoration of physical, mental, and spiritual balance through healing ceremoniesAns:A, C, DFeedback:African Americans have strong extended family relationships, with mother as head ofhousehold, and elder family members valued and respected. They also view health asharmony with nature, illness as disruption in harmony, and pain and suffering asinevitable, with relief achieved through prayers and laying on of hands. AsianAmericans combine complementary modalities with Western health care practices.Hispanics view health as God's will maintainable with a balance of hot and cold foodintake, and Native Americans see restoration of physical, mental, and spiritual balancethrough healing ceremonies.

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Page 11Origin: Chapter 2, 2121.The nurse is caring for a 4-year-old girl of Mexican descent who is recovering in thehospital following a diagnosis of epileptic seizures. The child's mother insists on a visitfrom hercuranderato provide healing powers to her daughter. What would be thebestintervention of the nurse in this situation?A)Explain to the mother that hospital policy does not allow visits from unlicensedpractitioners.B)Encourage the mother to arrange a visit with hercuranderawhen her daughter isreleased from the hospital.C)Discuss the situation with the child's physician and arrange for a visit from thecuranderaat the hospital if appropriate.D)Distract the child's mother from her demands by focusing on child and familyteaching related to her daughter's condition.Ans:CFeedback:Thecurandero(male) or thecurandera(female) of the Mexican American communityis believed to have healing powers as a gift from God. If the folk remedies or practicesof the folk healers are compatible with the health regimen and support appropriatehealth practices, these practices and beliefs do no harm; in fact, they may even benefitthe child and family. However, use of a folk healer can lead to a delay in beneficialtreatment or create other problems; therefore, the child's physician should be consultedprior to arranging a visit.Origin: Chapter 2, 2222.The pediatric nurse is caring for the families of immigrant migrant workers in a smalltown community. For which risk factor should the nurse provide screening?A)DiabetesB)DepressionC)Mental illnessD)Child abuseAns:BFeedback:Immigration can affect the health, educational, and social services provided in theUnited States. It also presents issues related to access to care and the types of care thatneed to be offered. Immigration imposes unique stresses on children and families,including depression, grief, or anxiety associated with migration and acculturation;separation from support systems; inadequate language skills in a society that is nottolerant of linguistic differences; disparities in social, professional, and economic statusbetween the country of origin and the United States; and traumatic events such as war orpersecution that may have occurred in their native country. The incidence of diabetes,mental illness, and child abuse is similar to the mainstream populations.

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Page 12Origin: Chapter 2, 2323.The school nurse is caring for a 10-year-old boy whose single mother's boyfriend isliving with them. Which may be an indicator of violence in the home?A)He expresses his feeling with art.B)He reports no health issues such as stomachaches.C)He recently started smoking.D)He is involved in after-school activities.Ans:CFeedback:Early initiation of smoking can be an indication of multiple adverse events of homeviolence. Expressing feelings with art and involvement in school activities can be acoping behavior or a sign that the child is well adjusted. Frequent stomachaches couldbe caused by anxiety about school.Origin: Chapter 2, 2424.The parents of a 14-year-old girl complain about the amount of time she spends on theInternet. Which question would the nurse ask the parents to assess her psychosocialdevelopment?A)"Do you limit her usage of the Internet to an hour per day?"B)"Does she do her homework and have fun with her peers?"C)"Did you place the computer where you can keep an eye on her?"D)"Did you warn her about protecting her identity online?"Ans:BFeedback:It helps to determine if the child is neglecting responsibilities or other forms of personalinteraction. After deciding that issue, the parents should determine what will bereasonable limits for the child's use of the Internet. Having the computer in a family areais better than putting it in her room, and warning her about protecting her identity is acritical safety issue.

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Page 13Origin: Chapter 2, 2525.The nurse is assessing a toddler for temperament and documents a 'difficult'temperament. Which traits are often seen in this type of personality?A)MoodinessB)IrritabilityC)Even-temperednessD)Overly activeE)Regular biologic functionsAns:B, DFeedback:Children's temperaments may be categorized into three major groups: easy, difficult,and slow to warm up. Easy children are even-tempered and have regular biologicalfunctions, predictable behavior, and a positive attitude toward new experiences.Difficult children are irritable, overactive, and intense; they react to new experiences bywithdrawing and are frustrated easily. Children in the slow-to-warm-up category aremoody and less active and have more irregular reactions; they react to new experienceswith mild but passive resistance and need extra time to adjust to new situations.Origin: Chapter 2, 2626.The nurse is talking with a newly married couple who are asking questions aboutgenetic testing. Which statement by the couple indicates the need for further teachingregarding genetics?A)"We are thankful that our child's temperament won't be anything like either of ourfathers' temperaments."B)"We have a 62. chance of our child being a boy!"C)"Genetic testing will help in identifying at least some genetic disorders."D)"We are glad that heart disease just runs in our family and can't be a geneticdisease."E)"Since both of our parents are Asian, we will definitely be having an Asian baby."Ans:A, DFeedback:A child's gender and race; the child's biological traits, including some behavioral traitsor aspects of temperament; and certain diseases or illnesses are directly linked to geneticinheritance. Stating that the child's temperament won't be like their grandfathers' andstating that heart disease can't be genetic warrants the nurse to further explain geneticinfluences on their future child's health.

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