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Test Bank For Wong's Essentials Of Pediatric Nursing, 9th Edition

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    Chapter 01: Perspectives of Pediatric Nursing Chapter 01: Perspectives of Pediatric Nursing MULTIPLE CHOICE 1. A nurse is planning a teaching session for parents of preschool children. Which statement explains why the nurse should include information about morbidity and mortality? a. Life-span statistics are included in the data. b. It explains effectiveness of treatment. c. Cost-effective treatment is detailed for the general population. d. High-risk age groups for certain disorders or hazards are identified. ANS: D Analysis of morbidity and mortality data provides the parents with information about which groups of individuals are at risk for which health problems. Life-span statistics is a part of the mortality data. Treatment modalities and cost are not included in morbidity and mortality data. PTS: 1 DIF: Cognitive Level: Apply REF: 6-8 TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Health Promotion and Maintenance 2. A clinic nurse is planning a teaching session about childhood obesity prevention for parents of school-age children. The nurse should include which associated risk of obesity in the teaching plan? a. Type I diabetes b. Respiratory disease c. Celiac disease d. Type II diabetes ANS: D Childhood obesity has been associated with the rise of type II diabetes in children. Type I diabetes is not associated with obesity and has a genetic component. Respiratory disease is not associated with obesity, and celiac disease is the inability to metabolize gluten in foods and is not associated with obesity. PTS: 1 DIF: Cognitive Level: Apply REF: 3 TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Health Promotion and Maintenance 3. Which is the leading cause of death in infants younger than 1 year? a. Congenital anomalies b. Sudden infant death syndrome

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    c. Respiratory distress syndrome d. Bacterial sepsis of the newborn ANS: A Congenital anomalies account for 20.1% of deaths in infants younger than 1 year. Sudden infant death syndrome accounts for 8.2% of deaths in this age group. Respiratory distress syndrome accounts for 3.4% of deaths in this age group. Infections specific to the perinatal period account for 2.7% of deaths in this age group. PTS: 1 DIF: Cognitive Level: Remember REF: 7 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance 4. Which leading cause of death topic should the nurse emphasize to a group of African-American boys ranging in ages 15 to 19 years? a. Suicide b. Cancer c. Firearm homicide d. Occupational injuries ANS: C Firearm homicide is the second overall cause of death in this age group and the leading cause of death in African-American males. Suicide is the third-leading cause of death in this population. Cancer, although a major health problem, is the fourth-leading cause of death in this age group. Occupational injuries do not contribute to a significant death rate for this age group. PTS: 1 DIF: Cognitive Level: Understand REF: 5 | 8 TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Health Promotion and Maintenance 5. Which is the major cause of death for children older than 1 year? a. Cancer b. Heart disease c. Unintentional injuries d. Congenital anomalies ANS: C Unintentional injuries (accidents) are the leading cause of death after age 1 year through adolescence. Congenital anomalies are the leading cause of death in those younger than 1 year. Cancer ranks either second or fourth, depending on the age group, and heart disease ranks fifth in the majority of the age groups. PTS: 1 DIF: Cognitive Level: Remember REF: 8 TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Health Promotion and Maintenance

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    6. Which is the leading cause of death from unintentional injuries for females ranging in age from 1 to 14? a. Mechanical suffocation b. Drowning c. Motor – vehicle-related fatalities d. Fire- and burn-related fatalities ANS: C Motor – vehicle-related fatalities are the leading cause of death for females ranging in age from 1 to 14, either as passengers or as pedestrians. Mechanical suffocation is fourth or fifth, depending on the age. Drowning is the second- or third-leading cause of death, depending on the age. Fire- and burn-related fatalities are the second- leading cause of death. PTS: 1 DIF: Cognitive Level: Remember REF: 4 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance 7. Which factor most impacts the type of injury a child is susceptible to, accord ing to the child’s age? a. Physical health of the child b. Developmental level of the child c. Educational level of the child d. Number of responsible adults in the home ANS: B The child’s developmental stage determines the type of injury that is likely to occur. The child’s physical health may facilitate the child’s recovery from an injury but does not impact the type of injury. Educational level is related to developmental level, but it is not as important as the ch ild’s developmental level in determining the type of injury. The number of responsible adults in the home may affect the number of unintentional injuries, but the type of injury is related to the child’s developmental stage. PTS: 1 DIF: Cognitive Level: Understand REF: 3-4 TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Health Promotion and Maintenance 8. Which is now referred to as the “new morbidity”? a. Limitations in the major activities of daily living b. Unintentional injuries that cause chronic health problems c. Discoveries of new therapies to treat health problems d. Behavioral, social, and educational problems that alter health ANS: D

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    The new morbidity reflects the behavioral, social, and educational problems that interfere with the child’s social and academ ic development. It is currently estimated that the incidence of these issues is from 5% to 30%. Limitations in major activities of daily living and unintentional injuries that result in chronic health problems are included in morbidity data. Discovery of new therapies would be reflected in changes in morbidity data over time. PTS: 1 DIF: Cognitive Level: Remember REF: 3 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance 9. A nurse on a pediatric unit is practicing family-centered care. Which is most descriptive of the care the nurse is delivering? a. Taking over total care of the child to reduce stress on the family b. Encouraging family dependence on health care systems c. Recognizing that the fa mily is the constant in a child’s life d. Excluding families from the decision-making process ANS: C The three key components of family-centered care are respect, collaboration, and support. Family-centered care recognizes the family as the constant in the child’s life. Taking over total care does not include the family in the process and may increase stress instead of reducing stress. The family should be enabled and empowered to work with the health care system. The family is expected to be part of the decision-making process. PTS: 1 DIF: Cognitive Level: Remember REF: 8 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Health Promotion and Maintenance 10. The nurse is preparing an in-service education to staff about atraumatic care for pediatric patients. Which intervention should the nurse include? a. Prepare the child for separation from parents during hospitalization by reviewing a video. b. Prepare the child before any unfamiliar treatment or procedure by demonstrating on a stuffed animal. c. Help the child accept the loss of control associated with hospitalization. d. Help the child accept pain that is connected with a treatment or procedure. ANS: B Preparing the child for any unfamiliar treatments, controlling pain, allowing privacy, providing play activities for expression of fear and aggression, providing choices, and respecting cultural differences are components of atraumatic care. In the provision of atraumatic care, the separation of child from parents during hospitalization is minimized. The nurse should promote a sense of control for the child. Preventing and minimizing bodily injury and pain are major components of atraumatic care. PTS: 1 DIF: Cognitive Level: Understand REF: 9 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Psychosocial Integrity

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    11. Which is most suggestive that a nurse has a nontherapeutic relationship with a patient and family? a. Staff is concerned about the nurse’s actions with the patient and family. b. Staff assignments allow the nurse to care for same patient and family over an extended time. c. Nurse is able to withdraw emotionally when emotional overload occurs but still remains committed. d. Nurse uses teaching skills to instruct patient and family rather than doing everything for them. ANS: A An important clue to a nontherapeutic staff-patient relationship is concern of other staff members. Allowing the nurse to care for the same patient over time would be therapeutic for the patient and family. Nurses who are able to somewhat withdraw emotionally can protect themselves while providing therapeutic care. Nurses using teaching skills to instruct patient and family will assist in transitioning the child and family to self-care. PTS: 1 DIF: Cognitive Level: Analyze REF: 9 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Psychosocial Integrity 12. Which is most descriptive of clinical reasoning? a. A simple developmental process b. Purposeful and goal-directed c. Based on deliberate and irrational thought d. Assists individuals in guessing what is most appropriate ANS: B Clinical reasoning is a complex, developmental process based on rational and deliberate thought. Clinical reasoning is not a developmental process. Clinical reasoning is based on rational and deliberate thought. Clinical reasoning is not a guessing process. PTS: 1 DIF: Cognitive Level: Understand REF: 12 TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Safe and Effective Care Environment: Management of Care 13. A nurse makes the decision to apply a topical anesthetic to a child’s skin before drawing blood. Which ethical principle is the nurse demonstrating? a. Autonomy b. Beneficence c. Justice d. Truthfulness ANS: B Beneficenc e is the obligation to promote the patient’s well -being. Applying a topical anesthetic before drawing blood promotes reducing the discomfort of the venipuncture. Autonomy is the patient’s right to be self -governing. Justice is the concept of fairness. Truthfulness is the concept of honesty.

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    PTS: 1 DIF: Cognitive Level: Understand REF: 11 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Physiological Integrity 14. Which action by the nurse demonstrates use of evidence-based practice (EBP)? a. Gathering equipment for a procedure b. Documenting changes in a patient’s status c. Questioning the use of daily central line dressing changes d. Clarifying a physician’s prescription for morphine ANS: C The nurse who questions the daily central line dressing change is ascertaining whether clinical interventions result in positive outcomes for patients. This demonstrates evidence-based practice (EBP), which implies questioning why something is effective and whether a better approach exists. Gathering equipment for a procedure and documenting changes in a patient’s status are practices that follow established guidelines. Clarifying a physician’s prescrip tion for morphine constitutes safe nursing care. PTS: 1 DIF: Cognitive Level: Apply REF: 11 TOP: Integrated Process: Nursing Process: Evaluation MSC: Area of Client Needs: Safe and Effective Care Environment: Management of Care 15. A nurse is admitting a toddler to the hospital. The toddler is with both parents and is currently sitting comfo rtably on a parent’s lap. The parents state they will need to leave for a brief period. Which type of nursing diagnosis should the nurse formulate for this child? a. Risk for anxiety b. Anxiety c. Readiness for enhanced coping d. Ineffective coping ANS: A A potential problem is categorized as a risk. The toddler has a risk to become anxious when the parents leave. Nursing interventions will be geared toward reducing the risk. The child is not showing current anxiety or ineffective coping. The child is not at a point for readiness for enhanced coping, especially because the parents will be leaving. PTS: 1 DIF: Cognitive Level: Remember REF: 12 TOP: Integrated Process: Nursing Process: Diagnosis MSC: Area of Client Needs: Health Promotion and Maintenance 16. A child has a postoperative appendectomy incision covered by a dressing. The nurse has just completed a prescribed dressing change for this child. Which description is an accurate documentation of this procedure?

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    a. Dressing change to appendectomy incision completed, child tolerated procedure well, parent present b. No complications noted during dressing change to appendectomy incision c. Appendectomy incision non-reddened, sutures intact, no drainage noted on old dressing, new dressing applied, procedure tolerated well by child d. No changes to appendectomy incisional area, dressing changed, child complained of pain during procedure, new dressing clean, dry and intact ANS: C The nurse should document assessments and reassessments. Appearance of the incision described in objective terms should be included during a dressing change. The nurse should document patient’s response and the outcomes of the care provided. In this example, these include drainage on th e old dressing, the application of the new dressing, and the child’s response. The other statements partially fulfill the requirements of documenting assessments and reassessments, patient’s response, and outcome, but do not include all three. PTS: 1 DIF: Cognitive Level: Analyze REF: 14 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Safe and Effective Care Environment: Management of Care 17. A nurse is planning a class on accident prevention for parents of toddlers. Which safety topic is the priority for this class? a. Appropriate use of car seat restraints b. Safety crossing the street c. Helmet use when riding a bicycle d. Poison control numbers ANS: A Motor vehicle accidents (MVAs) continue to be the most common cause of death in children older than 1 year, therefore the priority topic is appropriate use of car seat restraints. Safety crossing the street and bicycle helmet use are topics that should be included for preschool parents but are not priorities for parents of toddlers. Information about poison control is important for parents of toddlers and would be a safety topic to include but is not the priority over appropriate use of car seat restraints. PTS: 1 DIF: Cognitive Level: Apply REF: 3-4 TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Health Promotion and Maintenance MULTIPLE RESPONSE 1. Which behaviors by the nurse indicate a therapeutic relationship with children and families? (Select all that apply.) a. Spending off-duty time with children and families b. Asking questions if families are not participating in the care c. Clarifying information for families d. Buying toys for a hospitalized child

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    e. Learning about the family’s religious preferences ANS: B, C, E Asking questions if families are not participating in the care, clarifyin g information for families, and learning about the family’s religious preferences are positive actions and foster therapeutic relationships with children and families. Spending off-duty time with children and families and buying toys for a hospitalized child are negative actions and indicate overinvolvement with children and families, which is nontherapeutic. PTS: 1 DIF: Cognitive Level: Understand REF: 9-10 TOP: Integrated Process: Nursing Process: Evaluation MSC: Area of Client Needs: Psychosocial Integrity ESSAY 1. A nurse is formulating a clinical question for evidence-based practice. Place in order the steps the nurse should use to clarify the scope of the problem and clinical topic of interest. Begin with the first step of the process and proceed ordering the steps ending with the final step of the process. Provide answer as lowercase letters separated by commas (e.g., a, b, c, d, e). a. Intervention b. Outcome c. Population d. Time e. Control ANS: c, a, e, b, d When formulating a clinical question for evidence-based practice, the nurse should follow a concise, organized way that allows for clear answers. Good clinical questions should be asked in the PICOT (population, intervention, control, outcome, time) format to assist with clarity and literature searching. PICOT questions assist with clarifying the scope of the problem and clinical topic of interest. PTS: 1 DIF: Cognitive Level: Understand REF: 11 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance Chapter 02: Community-Based Nursing Care of the Child and Family Chapter 02: Community-Based Nursing Care of the Child and Family MULTIPLE CHOICE

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    1. Which term best describes the identification of the distribution and causes of disease, injury, or illness? a. Nursing process b. Epidemiologic process c. Community-based statistics d. Mortality and morbidity statistics ANS: B Epidemiology is the science of population health applied to the detection of morbidity and mortality in a population. It identifies the distribution and causes of diseases across a population. Nursing process is a systematic problem-solving approach for the delivery of nursing care. Morbidity and mortality statistics, along with natal rates, may provide an objective picture of a community’s health status. PTS: 1 DIF: Cognitive Level: Remember REF: 18 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance 2. A community nurse at the health department is trying to identify how many new cases of acquired immunodeficiency syndrome (AIDS) disease have occurred in the city this past year. Which statistic should the nurse examine? a. Mortality b. Morbidity c. Incidence d. Prevalence ANS: C Incidence will provide the number of cases of a particular disease process. Mortality statistics specify the number of deaths from a given cause. Morbidity statistics specify the prevalence of specific illnesses in a population at a particular time. PTS: 1 DIF: Cognitive Level: Understand REF: 18 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance 3. A nurse is collecting subjective and objective information about target populations to diagnose problems based on community needs. This describes which step in the community nursing process?

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    a. Planning b. Diagnosis c. Assessment d. Establishing objectives ANS: C The nursing process stages are similar, whether the client is one child or a population of children. The assessment phase of the nursing process focuses on collecting subjective and objective data. Planning is the development of community-centered goals and objectives. Diagnosis is the identification of problems specific to the community. PTS: 1 DIF: Cognitive Level: Understand REF: 19 TOP: Integrated Process: Communication and Documentation MSC: Area of Client Needs: Safe and Effective Care Environment: Management of Care 4. A nurse is establishing several health programs, such as bicycle safety, to improve the health status of a target population. This describes which step in the community nursing process? a. Planning b. Evaluation c. Assessment d. Implementation ANS: D The nurse working with the community to put into practice a program to reach community goals is the implementation phase of the community nursing process. Planning involves designing the program to meet community-centered goals. The evaluation stage would determine the effectiveness of the program. During the assessment phase, the nurse would identify the resources necessary and the barriers that would interfere with implementation. PTS: 1 DIF: Cognitive Level: Understand REF: 19 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Safe and Effective Care Environment: Management of Care 5. A school nurse is conducting vision and hearing testing on fifth-grade children. Which level of prevention is the nurse demonstrating? a. Primary b. Secondary

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    c. Tertiary d. Health promotion ANS: B Secondary prevention focuses on screening and early diagnosis of disease. Vision and hearing testing are screening tests to detect problems. Primary prevention focuses on health promotion and prevention of disease or injury. Tertiary prevention focuses on optimizing function for children with a disability or chronic disease. Health promotion is focused on preventing disease or illness. PTS: 1 DIF: Cognitive Level: Understand REF: 19 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Health Promotion and Maintenance 6. A community health nurse is collecting assessment data by interviewing community leaders. What type of assessment is this community nurse conducting? a. Subjective b. Windshield survey c. Objective d. Statistical ANS: A Subjective information indicates what community members say are their most important needs. Interviewing community leaders would be a subjective assessment. Objective information is data that the nurse collects either by direct observation or through written sources. A windshield tour is one method of direct observation. Statistics would be objective information gathering. PTS: 1 DIF: Cognitive Level: Understand REF: 19 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance MULTIPLE RESPONSE 1. Which interventions by a community can be classified as primary prevention interventions? (Select all that apply.) a. Administering immunizations b. Teaching a child with asthma how to use an inhaler c. Conducting scoliosis screening exams d. Teaching a community parenting class

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    e. Conducting assessments at a well-child care clinic ANS: A, D, E Primary prevention focuses on health promotion and prevention of disease or injury. Examples of primary prevention activities include well-child care clinics; immunization programs; safety programs (bike helmets, car seats, seat belts, childproof containers); nutrition programs; environmental efforts (clean air programs); sanitation measures (chlorinated water, garbage removal, sewage treatment); and community parenting classes. Teaching a child how to use an inhaler is tertiary prevention and conducting scoliosis screening exams is secondary prevention. PTS: 1 DIF: Cognitive Level: Apply REF: 19 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Health Promotion and Maintenance Chapter 03: Family Influences on Child Health Promotion Chapter 03: Family Influences on Child Health Promotion MULTIPLE CHOICE 1. A nurse is selecting a family theory to assess a patient’s family dynamics. Which fam ily theory best describes a series of tasks for the family throughout its life span? a. Interactional theory b. Developmental systems theory c. Structural-functional theory d. Duvall’s developmental theory ANS: D Duvall’s developmental theory describes eig ht developmental tasks of the family throughout its life span. Interactional theory and structural-functional theory are not family theories. Developmental systems theory is an outgrowth of Duvall’s theory. The family is described as a small group, a semiclosed system of personalities that interact with the larger cultural system. Changes do not occur in one part of the family without changes in others. PTS: 1 DIF: Cognitive Level: Understand REF: 24-26 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

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    2. Which family theory explains how families react to stressful events and suggests factors that promote adaptation to these events? a. Interactional theory b. Developmental systems theory c. Family stress theory d. Duvall’s developmental theory ANS: C Family stress theory explains the reaction of families to stressful events. In addition, the theory helps suggest factors that promote adaptation to the stress. Stressors, both positive and negative, are cumulative and affect the family. Adaptation requires a change in family structure or interaction. Interactional theory is not a family theory. Interactions are the basis of general systems theory. Developmental systems theory is an outgrowth of Duvall ’s theory. The family is described as a small group, a semiclosed system of personalities that interact with the larger cultural system. Changes do not occur in one part of the family without changes in others. Duvall’s developmental theory describes eight developmental tasks of the family throughout its life span. PTS: 1 DIF: Cognitive Level: Understand REF: 24 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance 3. Which is the term for a family in which the paternal grandmother, the parents, and two minor children live together? a. Blended b. Nuclear c. Binuclear d. Extended ANS: D An extended family contains at least one parent, one or more children, and one or more members (related or unrelated) other than a parent or sibling. A blended family contains at least one step- parent, step-sibling, or half-sibling. The nuclear family consists of two parents and their children. No other relatives or nonrelatives are present in the household. In binuclear families, parents continue the parenting role while terminating the spousal unit. For example, when joint custody is assigned by the court, each parent has equal rights and responsibilities for the minor child or children.

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    PTS: 1 DIF: Cognitive Level: Remember REF: 24-26 TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Health Promotion and Maintenance 4. A nurse is assessing a family’s structure. Which describes a family in which a mother, her children, and a stepfather live together? a. Blended b. Nuclear c. Binuclear d. Extended ANS: A A blended family contains at least one step-parent, step-sibling, or half-sibling. The nuclear family consists of two parents and their children. No other relatives or nonrelatives are present in the household. In binuclear families, parents continue the parenting role while terminating the spousal unit. For example, when joint custody is assigned by the court, each parent has equal rights and responsibilities for the minor child or children. An extended family contains at least one parent, one or more children, and one or more members (related or unrelated) other than a parent or sibling. PTS: 1 DIF: Cognitive Level: Understand REF: 24-26 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance 5. Which is considered characteristic of children who are the youngest in their family? a. More dependent than firstborn children b. More outgoing than firstborn children c. Identify more with parents than with peers d. Are subject to greater parental expectations ANS: B Later-born children are obliged to interact with older siblings from birth and seem to be more outgoing and make friends more easily than firstborns. Being more dependent, identifying more with parents than peers, and being subject to greater parental expectations are characteristics of firstborn children and only children.

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    PTS: 1 DIF: Cognitive Level: Understand REF: 29-30 TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Health Promotion and Maintenance 6. Parents of a firstborn child are asking whether it is normal for their child to be extremely competitive. The nurse should respond to the parents that studies about the ordinal position of children suggest that firstborn children tend to: a. be praised less often. b. be more achievement oriented. c. be more popular with the peer group. d. identify with peer group more than parents. ANS: B Firstborn children, like only children, tend to be more achievement-oriented. Being praised less often, being more popular with the peer group, and identifying with peer groups more than parents are characteristics of later-born children. PTS: 1 DIF: Cognitive Level: Apply REF: 29 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Health Promotion and Maintenance 7. A 35-year-old client is currently on fertility treatments. When responding to a question from the client about multiple births, which statement by the nurse is accurate? a. Use of fertility treatments has been associated with an increase in multiple births. b. Your chance of having multiple births is at the same rate as all women of childbearing age. c. There is not enough evidence about the use of fertility treatments increasing the rate of multiple births. d. Because of your age and the fertility treatments, you have almost a 100% chance of a multiple birth. ANS: A Because women in their thirties are almost 2.5 times as likely as women in their twenties to have higher-order plural births, increased childbearing among older women and the expanded use of fertility drugs have been associated with an increase in the multiple-birth ratio. The rate of having a multiple birth for this client is not the same for all women of childbearing age. There are data indicating that fertility treatments increase the rate of multiple births, but fertility treatments do not have a 100% rate of multiple births.

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    PTS: 1 DIF: Cognitive Level: Understand REF: 30 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Health Promotion and Maintenance: Family Systems 8. Nicole and Kelly, age 5 years, are identical twins. Their parents tell the nurse that the girls always want to be together. The nurse’s suggestions should be based o n which statement? a. Some twins thrive best when they are constantly together. b. Individuation cannot occur if twins are together too much. c. Separating twins at an early age helps them develop mentally. d. When twins are constantly together, pathologic bonding occurs. ANS: A Twins work out a relationship that is reasonably satisfactory to both. They develop a remarkable capacity for cooperative play and considerable loyalty and generosity toward each other. Parents should foster individual differences and allow the children to follow their natural inclinations. Individuation does occur. In twinship, one member of the pair is more dominant, outgoing, and assertive than the other. Early separation may produce unnecessary stresses for the children. There is no evidence that pathologic bonding occurs when twins are constantly together. PTS: 1 DIF: Cognitive Level: Understand REF: 30-31 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Health Promotion and Maintenance 9. The nurse is teaching a group of new parents about the experience of role transition. Which statement by a parent would indicate a correct understanding of the teaching? a. “My marital relationship can have a positive or negative effect on the role transition.” b. “If an infant has special care needs, the parents’ sense of confidence in their new role is strengthened.” c. “Young parents can adjust to the new role easier than older parents.” d. “A parent’s previous experience with children makes the role transition more difficult.” ANS: A If parents are supportive of each other, they can serve as positive influences on establishing satisfying parental roles. When marital tensions alter caregiving routines and interfere with the enjoyment of the infant, then the marital relationship has a negative effect. Infants with special care needs can be a significant source of added stress. Older parents are usually more able to cope with the greater financial responsibilities, changes in sleeping habits, and reduced time for each other and

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    other children. Parents who have previous experience with parenting appear more relaxed, have less conflict in disciplinary relationships, and are more aware of normal growth and development. PTS: 1 DIF: Cognitive Level: Understand REF: 31-32 TOP: Integrated Process: Nursing Process: Evaluation MSC: Area of Client Needs: Health Promotion and Maintenance 10. When assessing a family, the nurse determines that the parents exert little or no control over their children. This style of parenting is called: a. permissive. b. dictatorial. c. democratic. d. authoritarian. ANS: A Permissive parents avoid imposing their own standards of conduct and allow their children to regulate their own activity as much as possible. The parents exert little or no control over their children’s actions. Dictatorial or authoritarian parents attempt to control their children’s behavior and attitudes through unquestioned mandates. They establish rules and regulations or standards of conduct that they expect to be followed rigidly and unquestioningly. Democratic parents combine permissive and dictatorial styles. They direct their children’s behavior and attitudes by emphasizing the reasons for rules and negatively reinforcing deviations. They respect the child’s individual nature. PTS: 1 DIF: Cognitive Level: Remember REF: 33 TOP: Integrated Process: Nursing Process: Diagnosis MSC: Area of Client Needs: Health Promotion and Maintenance 11. When discussing discipline with the mother of a 4-year-old child, the nurse should include which instruction? a. Children as young as 4 years old rarely need to be punished. b. Parental control should be consistent. c. Withdrawal of love and approval is effective at this age. d. One should expect rules to be followed rigidly and unquestioningly. ANS: B For effective discipline, parents must be consistent and must follow through with agreed-on actions. Realistic goals should be set for this age group. Parents should structure the environment to prevent

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    unnecessary difficulties. Requests for behavior change should be phrased in a positive manner to provide direction for the child. Withdrawal of love and approval is never appropriate or effective. Discipline strategies should be appropriate to the child’s age, temperament, and severity of the misbehavior. Following rules rigidly and unquestioningly is beyond the developmental capabilities of a 4-year-old. PTS: 1 DIF: Cognitive Level: Apply REF: 33 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance 12. Which is most characteristic of the physical punishment of children, such as spanking? a. Psychological impact is usually minimal. b. Children rarely become accustomed to spanking. c. Children’s development of reasoning increases. d. Misbehavior is likely to occur when parents are not present. ANS: D Through the use of physical punishment, children learn what they should not do. When parents are not around, it is more likely that children will misbehave because they have not learned to behave well for their own sake, but rather out of fear of punishment. Spanking can cause severe physical and psychological injury and interfere with effective parent-child interaction. Children do become accustomed to spanking, requiring more severe corporal punishment each time. The use of corporal punishment may interfere with the child’s development of moral reasoning. PTS: 1 DIF: Cognitive Level: Understand REF: 35 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance 13. A 3-year-old girl was adopted immediately after birth. The parents have just asked the nurse how they should tell the child that she is adopted. Which guidelines concerning adoption should the nurse use in planning a response? a. Telling the child is an important aspect of their parental responsibilities. b. The best time to tell the child is between ages 7 and 10 years. c. It is not necessary to tell the child who was adopted so young. d. It is best to wait until the child asks about it. ANS: A

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    It is important for the parents not to withhold information about the adoption from the child. It is an essential component of the child’s identity. There is no recommended best time to tell children. It is believed that children should be told young enough so they do not remember a time when they did not know. It should be done before the children enter school to keep third parties from telling the children before the parents have had the opportunity. PTS: 1 DIF: Cognitive Level: Understand REF: 36 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance 14. A parent of a school-age child is going through a divorce. The parent tells the school nurse the child has not been doing well in school and sometimes has trouble sleeping. The nurse should recognize this as which implication? a. Indication of maladjustment b. Common reaction to divorce c. Lack of adequate parenting d. Unusual response that indicates need for referral ANS: B Parental divorce affects school-age children in many ways. In addition to difficulties in school, they often have profound sadness, depression, fear, insecurity, frequent crying, loss of appetite, and sleep disorders. This is not an indication of maladjustment, suggestive of lack of adequate parent, or an unusual response that indicates need for referral in school-age children after parental divorce. PTS: 1 DIF: Cognitive Level: Apply REF: 37 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Psychosocial Integrity 15. A mother brings 6-month-old Eric to the clinic for a well- baby checkup. She comments, “I want to go back to work, but I don’t want Eric to suffer because I’ll have less time with him.” The nurse’s most appropriate answer would be which statement? a. “I’m sure he’ll be fine if you get a good babysitter.” b. “You will need to stay home until Eric starts school.” c. “You should go back to work so Eric will get used to being with others.” d. “Let’s talk about the child - care options that will be best for Eric.” ANS: D

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    Le t’s talk about the child -care options that will be best for Eric is an open-ended statement that will assist the mother in exploring her concerns about what is best for both her and Eric. I’m sure he’ll be fine if you get a good babysitter, You will need to stay home until Eric starts school, and You should go back to work so Eric will get used to being with others are directive statements. They do not address the effect of her working on Eric. PTS: 1 DIF: Cognitive Level: Apply REF: 40 TOP: Integrated Process: Communication and Documentation MSC: Area of Client Needs: Psychosocial Integrity MULTIPLE RESPONSE 1. Dunst, Trivette, and Deal identified the qualities of strong families that help them function effectively. Which qualities are included? (Select all that apply.) a. Ability to stay connected without spending time together b. Clear set of family values, rules, and beliefs c. Adoption of one coping strategy that always promotes positive functioning in dealing with life events d. Sense of commitment toward growth of individual family members as opposed to that of the family unit e. Ability to engage in problem-solving activities f. Sense of balance between the use of internal and external family resources ANS: B, E, F A clear set of family rules, values, and beliefs that establishes expectations about acceptable and desired behavior is one of the qualities of strong families that help them function effectively. Strong families also are able to engage in problem-solving activities and to find a balance between internal and external forces. Strong families have a sense of congruence among family members regarding the value and importance of assigning time and energy to meet needs. Strong families also use varied coping strategies. The sense of commitment is toward the growth and well-being of individual family members, as well as the family unit. PTS: 1 DIF: Cognitive Level: Understand REF: 28 TOP: Integrated Process: Nursing Process: Diagnosis MSC: Area of Client Needs: Health Promotion and Maintenance

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    2. A nurse is conducting a teaching session on the use of time-out as a discipline measure to parents of toddlers. Which are correct strategies the nurse should include in the teaching session? (Select all that apply.) a. Time-out as a discipline measure cannot be used when in a public place. b. A rule for the length of time-out is 1 minute per year. c. When the child misbehaves, one warning should be given. d. The area for time-out can be in the family room where the child can see the television. e. When the child is quiet for the specified time, he or she can leave the room. ANS: B, C, E A rule for the length of time-out is 1 minute per year of age; use a kitchen timer with an audible bell to record the time rather than a watch. When the child misbehaves, one warning should be given. When the child is quiet for the duration of the time, he or she can then leave the room. Time-out can be used in public places and the parents should be consistent on the use of time-out. Implement time- out in a public place by selecting a suitable area or explain to children that time-out will be spent immediately on returning home. The time-out should not be spent in an area from which the child can view the television. Select an area for time-out that is safe, convenient, and unstimulating but where the child can be monitored, such as the bathroom, hallway, or laundry room. PTS: 1 DIF: Cognitive Level: Apply REF: 35 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance 3. Divorced parents of a preschool child are asking whether their child will display any feelings or behaviors related to the effect of the divorce. The nurse is correct when explaining that the parents should be prepared for which type of behaviors? (Select all that apply.) a. Displaying fears of abandonment b. Verbalizing that he or she “is the reason for the divorce” c. Displaying fear regarding the future d. Ability to disengage from the divorce proceedings e. Engaging in fantasy to understand the divorce ANS: A, B, E A child 3 to 5 years of age (preschool) may display fears of abandonment, verbalize feelings that he or she is the reason for the divorce, and engage in fantasy to understand the divorce. They would not

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    be displaying fear regarding the future until school age, and the ability to disengage from the divorce proceedings would be characteristic of an adolescent. PTS: 1 DIF: Cognitive Level: Apply REF: 38 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Teaching and Learning COMPLETION 1. A nurse is admitting a child, in foster care, to the hospital. The nurse recognizes that foster parents care for the child _____ hours a day. (Record your answer as a whole number.) ANS: 24 The term foster care is defined as 24-hour substitute care for children outside of their own homes. PTS: 1 DIF: Cognitive Level: Understand REF: 41 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance 2. A parent of a newborn is expressing concern about returning to work after taking time off under the Family and Medical Leave Act (FMLA). The nurse understands that the Act allows a new parent to take off from work for _____ weeks. (Record your answer as a whole number.) ANS: 12 The passage of the Family and Medical Leave Act (FMLA) in 1993 set the stage for a greater focus on the issues of contemporary families. FMLA allows eligible employees to take up to 12 weeks of unpaid leave each year to care for newborn or newly adopted children, parents, or spouses who have serious health conditions or to recover from their own serious health condition. PTS: 1 DIF: Cognitive Level: Understand REF: 41 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance Chapter 04: Social, Cultural, and Religious Influences on Child Health Promotion

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    Chapter 04: Social, Cultural, and Religious Influences on Child Health Promotion MULTIPLE CHOICE 1. Which term best describes a group of people who share a set of values, beliefs, practices, social relationships, law, politics, economics, and norms of behavior? a. Race b. Culture c. Ethnicity d. Social group ANS: B Culture is a pattern of assumptions, beliefs, and practices that unconsciously frames or guides the outlook and decisions of a group of people. A culture is composed of individuals who share a set of values, beliefs, and practices that serve as a frame of reference for individual perceptions and judgments. Race is defined as a division of mankind possessing traits that are transmissible by descent and are sufficient to characterize it as a distinct human type. Ethnicity is an affiliation of a set of persons who share a unique cultural, social, and linguistic heritage. A social group consists of systems of roles carried out in groups. Examples of primary social groups include the family and peer groups. PTS: 1 DIF: Cognitive Level: Remember REF: 44 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Psychosocial Integrity 2. Which term best describes the emotional attitude that one’s own ethnic group is superior to others? a. Culture b. Ethnicity c. Superiority d. Ethnocentrism ANS: D Ethnocentrism is the belief that one’s way of living and behaving is the best way. This includes the emotiona l attitude that the values, beliefs, and perceptions of one’s ethnic group are superior to those of others. Culture is a pattern of assumptions, beliefs, and practices that unconsciously frames or guides the outlook and decisions of a group of people. A culture is composed of individuals who share a set of values, beliefs, and practices that serves as a frame of reference for individual

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    perception and judgments. Ethnicity is an affiliation of a set of persons who share a unique cultural, social, and linguistic heritage. Superiority is the state or quality of being superior; it does not include ethnicity. PTS: 1 DIF: Cognitive Level: Understand REF: 47 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Psychosocial Integrity 3. Currently, the fastest-growing segment of the homeless population in the United States consists of: a. families. b. “runaway” adolescents. c. migrant farm workers. d. individuals with mental disorders. ANS: A Homeless individuals lack resources and community ties necessary to provide for their own adequate shelter. One of the most pressing problems in the United States is the rapidly growing number of homeless families, which currently account for 50% of the nation’s homeless. “Runaway” (or throwaway) adolescents are often victims of physical and social abuse. Although it is a significant issue, this is not the fastest-growing segment of the homeless population. Migrant farm workers form one of the most severely disadvantaged groups in the United States. They have a mobile existence, which is detrimental for children. They do not constitute the fastest-growing segment of the homeless population. Individuals with mental disorders may be homeless. They do not constitute the fastest- growing segment of the homeless population. PTS: 1 DIF: Cognitive Level: Understand REF: 51 TOP: Integrated Process: Nursing Process: Evaluation MSC: Area of Client Needs: Psychosocial Integrity 4. Maria, a Spanish-speaking 5-year-old girl, has started kindergarten in an English-speaking school. Crying most of the time, she appears helpless and unable to function in this new situation. Which description best explains Maria’s behavior? a. Lacks adequate culture for attending school b. Lacks the maturity needed in school c. Is experiencing culture shock d. Is experiencing minority group discrimination

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    ANS: C Culture shock is the helpless feeling and state of disorientation felt by an outsider attempting to adapt to a different culture group. Her inability to speak English inhibits her ability to interact. This would explain Maria’s inability to function in this new situation. There is no evidence to support that Maria lacks adequate culture or maturity needed in school, or that she is experiencing minority group discrimination. PTS: 1 DIF: Cognitive Level: Analyze REF: 46 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Psychosocial Integrity 5. When minority groups immigrate to another country, a certain degree of cultural or ethnic blending occurs through the involuntary process of: a. acculturation. b. ethnocentrism. c. culture shock. d. cultural sensitivity. ANS: A Acculturation is the gradual changes that are produced in a culture by the influence of another culture that cause one or both cultures to become more similar. The minority culture is forced to learn the majority culture to survive. Ethnocentrism is the belief that one’s way of living and behaving is the best way. This includes the emotional attitude that the values, beliefs, and perceptions of one’ s ethnic group are superior to those of others. This would limit the blending. Culture shock is the helpless feeling and state of disorientation felt by an outsider attempting to adapt to a different culture group. This would limit the blending. Cultural sensitivity is an awareness of cultural similarities and differences. The nurse should develop the dynamics of cultural sensitivity to provide culturally competent care. PTS: 1 DIF: Cognitive Level: Understand REF: 46 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Psychosocial Integrity 6. Which is a frequent health problem of migrant children and adolescents in the United States? a. Suicide b. Diabetes

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    c. Tuberculosis d. Cardiovascular disease ANS: C The rate of tuberculosis among migrant families is high. A high-risk factor for the children of migrant families is the migration of the families from areas that have high prevalence of tuberculosis; significant health issues, suicide, diabetes, and cardiovascular disease are not more prevalent in this population. PTS: 1 DIF: Cognitive Level: Understand REF: 51-52 TOP: Integrated Process: Nursing Process: Evaluation MSC: Area of Client Needs: Health Promotion and Maintenance 7. The nurse observes that the families who do not show up for scheduled clinic appointments are usually from minority cultural groups. The best explanation for this is that these families often differ from the dominant culture because they: a. lack education. b. avoid health care. c. are more forgetful. d. view time differently. ANS: D Each cultural group has different conceptions of time and waiting. The dominant culture in the United States has a fairly rigid view of time. Other cultures may be late or miss activities because other issues take precedence over the appointment. Education is not the issue. It is the concept of time in the cultural group. It is not done to avoid health care. The family usually believes that the appointment can be made for a later time. The family does not forget the time, but other issues take priority. PTS: 1 DIF: Cognitive Level: Apply REF: 52 TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Psychosocial Integrity 8. The Vietnamese mother of a child being seen in the clinic avoids eye contact with the nurse. The best explanation for this, considering cultural differences, is that the parent: a. feels responsible for her child’s illness. b. feels inferior to the nurse.

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    c. is embarrassed to seek health care. d. is showing respect for the nurse. ANS: D In some ethnic groups, eye contact is avoided. In the Vietnamese culture, an individual may not look directly into the nurse’s eyes as a sign of respect. The nurse providing culturally competent care would recognize that feeling responsible for the illness, feeling inferior, or embarrassment are not reasons for the mother to avoid eye contact with the nurse. PTS: 1 DIF: Cognitive Level: Understand REF: 54 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Psychosocial Integrity 9. The belief that health is “a state of harmony with nature and the universe” is common in which culture? a. Japanese b. African-American c. Native American d. Hispanic-American ANS: C Many cultures ascribe attributes of health to natural forces. Many individuals of the Native-American culture view health as a state of harmony with nature and the universe. This belief is not consistent with the Japanese, African-American, or Hispanic-American cultural groups. PTS: 1 DIF: Cognitive Level: Remember REF: 59 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Psychosocial Integrity 10. A Hispanic toddler has pneumonia. The nurse notices that the parent consistently feeds the child only the broth that comes on the clear liquid tray. Food items, such as Jell-O, Popsicle, and juices are left. Which statement would best explain this? a. Parent is trying to feed child only what child likes most. b. Parent is trying to restore normal balance through appropriate “hot” remedies. c. Hispanics be lieve the “evil eye” enters when a person gets cold. d. Hispanics believe an innate energy, called chi, is strengthened by eating soup. ANS: B

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    In several groups, including Filipino, Chinese, Arabic, and Hispanic cultures, hot and cold describe certain properties completely unrelated to temperature. Respiratory conditions such as pneumonia are “cold” conditions and are treated with “hot” foods. The parent may be trying to feed the child only what the child likes most, but it is unlikely that a toddler would consistently prefer the broth to Jell- O, Popsicle, and juice. The evil eye applies to a state of imbalance of health, not curative actions. Chinese individuals believe in chi as an innate energy. PTS: 1 DIF: Cognitive Level: Apply REF: 59 TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Psychosocial Integrity 11. A nurse is taking a history on a low-income Hispanic toddler. The parent tells the nurse that occasional diarrhea is treated with azogue, a mercury compound commonly us ed in the parent’s native Mexico. What should the nurse recognize about this remedy? a. It is harmless. b. It is dangerous. c. It has a scientific basis. d. It has importance in certain religious practices. ANS: B The ingestion of mercury is extremely dangerous for children. Solutions containing mercury are not harmless. The nurse should work with folk healers or respected members of the culture to teach the family of the dangers of mercury ingestion. No scientific basis exists for the use of mercury to treat diarrhea. PTS: 1 DIF: Cognitive Level: Understand REF: 56 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Psychosocial Integrity 12. The nurse discovers welts on the back of a Vietnamese child during a home health visit. The child’s mother says she has rubbed the edge of a coin on her child’s oiled skin. What explanation should the nurse recognize about this? a. Child abuse b. Cultural practice to rid the body of disease c. Cultural practice to treat enuresis or temper tantrums d. Child discipline measure common in the Vietnamese culture

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    ANS: B Rubbing the edge of a coin on a child’s oiled skin is descriptive of coining. The welts are created by repeatedly rubbing a coin on the child’s oiled skin. The mother is attempting to rid the child’s body of disease. The mother was engaged in an attempt to heal the child. This is not child abuse or discipline. PTS: 1 DIF: Cognitive Level: Understand REF: 56 TOP: Integrated Process: Nursing Process: Evaluation MSC: Area of Client Needs: Psychosocial Integrity: Cultural Diversity 13. The father of a hospitalized child tells the nurse, “He can’t have meat. We are Buddhist and vegetarians.” The nurse’s best intervention is to: a. order the child a meatless tray. b. ask a Buddhist priest to visit. c. explain that hospital patients are exempt from dietary rules. d. help the parent understand that meat provides protein needed for healing. ANS: A It is essential for the nurse to respect the religious practices of the child and family. The nurse should arrange a dietary consult to ensure that nutritionally complete vegetarian meals are prepared by the hospital kitchen. It is not necessary to ask a Buddhist priest to visit. The nurse should be able to arrange for a vegetarian tray. The nurse should not encourage the child and parent to go against their religious beliefs. Nutritionally complete, acceptable vegetarian meals should be provided. PTS: 1 DIF: Cognitive Level: Apply REF: 61 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Psychosocial Integrity 14. In which cultural group is good health considered to be a balance between yin and yang? a. Asians b. Australian aborigines c. Native Americans d. African-Americans ANS: A In Chinese health beliefs, the forces termed yin and yang must be kept in balance to maintain health.

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    The belief in this balance is not consistent with Australian aborigines, Native Americans, or African- Americans. PTS: 1 DIF: Cognitive Level: Remember REF: 58 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Psychosocial Integrity 15. A young child from Mexico is hospitalized for a serious illness. The father tells the nurse that the child is being punished by God for being bad. The nurse should recognize that this is a(n): a. health belief common in this culture. b. early indication of potential child abuse. c. misunderstanding of the family’s common beliefs. d. belief common when fortune tellers have been used. ANS: A A common health belief in the Mexican-American cultural group is that health is controlled by the environment, fate, and the will of God. The father’s comment has no relation to child abuse. The father would not misunderstand the family’s beliefs. It is a cultural belief that health is controlled by the environment, fate, and the will of God. Mexicans may use the services of curandero (healers), not fortune tellers. PTS: 1 DIF: Cognitive Level: Apply REF: 59 TOP: Integrated Process: Nursing Process: Evaluation MSC: Area of Client Needs: Psychosocial Integrity MULTIPLE RESPONSE 1. Children are taught the values of their culture through observation and feedback, relative to their own behavior. In teaching a class on cultural competence, the nurse should be aware that which factor(s) may be culturally determined? (Select all that apply.) a. Degree of competition b. Racial variation c. Determination of status d. Social roles e. Geographic boundaries ANS: A, C, D Degree of competition, determination of status, and social roles are all factors that are determined by

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