Test Bank For Wongs Nursing Care Of Infants And Children, 10th Edition

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01: Perspectives of Pediatric NursingChapter 01: Perspectives of Pediatric NursingMULTIPLE CHOICE1.The clinic nurse is reviewing statistics on infant mortality for the United Statesversus other countries. Compared with other countries that have a population of atleast 25 million, the nurse makes which determination?a.TheUnitedStatesisrankedlastamong27countries.b.TheUnitedStatesisrankedsimilarto20otherdevelopedcountries.c.TheUnitedStatesisrankedinthemiddleof20otherdevelopedcountries.d.TheUnitedStatesisrankedhighestamong27otherindustrializedcountries.ANS: AAlthough the death rate has decreased, the United States still ranks last in infantmortality among nations with a population of at least 25 million. The United Stateshas the highest infant death rate of developed nations.DIF: Cognitive Level: Remembering REF: p. 6TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance2.Which is the leading cause of death in infants younger than 1 year in the UnitedStates?a.Congenitalanomaliesb.Suddeninfantdeathsyndromec.Disordersrelatedtoshortgestationandlowbirthweightd.MaternalcomplicationsspecifictotheperinatalperiodANS: ACongenital anomalies account for 20.1% of deaths in infants younger than 1 yearcompared with sudden infant death syndrome, which accounts for 8.2%; disordersrelated to short gestation and unspecified low birth weight, which account for 16.5%;and maternal complications such as infections specific to the perinatal period, whichaccount for 6.1% of deaths in infants younger than 1 year of age.DIF: Cognitive Level: Remembering REF: p. 7 TOP: Nursing Process: PlanningMSC: Client Needs: Health Promotion and Maintenance3.What is the major cause of death for children older than 1 year in the United States?a.Heartdisease

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b.Childhoodcancerc.Unintentionalinjuriesd.CongenitalanomaliesANS: CUnintentional injuries (accidents) are the leading cause of death after age 1 yearthrough adolescence. The leading cause of death for those younger than 1 year iscongenital anomalies, and childhood cancers and heart disease cause a significantlylower percentage of deaths in children older than 1 year of age.DIF: Cognitive Level: Understanding REF: p. 7 TOP: Nursing Process: PlanningMSC: Client Needs: Health Promotion and Maintenance4.In addition to injuries, what are the leading causes of death in adolescents ages 15 to19 years?a.Suicideandcancerb.Suicideandhomicidec.Drowningandcancerd.HomicideandheartdiseaseANS: BSuicide and homicide account for 16.7% of deaths in this age group. Suicide andcancer account for 10.9% of deaths, heart disease and cancer account forapproximately 5.5%, and homicide and heart disease account for 10.9% of the deathsin this age group.DIF: Cognitive Level: Remembering REF: p. 7 TOP: Nursing Process: PlanningMSC: Client Needs: Health Promotion and Maintenance5.The nurse is planning a teaching session to adolescents about deaths byunintentional injuries. Which should the nurse include in the session with regard todeaths caused by injuries?a.Moredeathsoccurinmales.b.Moredeathsoccurinfemales.c.Thepatternofdeathsdoesnotvaryaccordingtoageandsex.d.Thepatternofdeathsdoesnotvarywidelyamongdifferentethnicgroups.ANS: A

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The majority of deaths from unintentional injuries occur in males. The pattern ofdeath does vary greatly among different ethnic groups, and the causes of unintentionaldeaths vary with age and gender.DIF: Cognitive Level: Applying REF: pp. 7-8TOP: Integrated Process: Teaching/LearningMSC: Client Needs: Health Promotion and Maintenance6.What do mortality statistics describe?a.Diseaseoccurringregularlywithinageographiclocationb.Thenumberofindividualswhohavediedoveraspecificperiodc.Theprevalenceofspecificillnessinthepopulationataparticulartimed.DiseaseoccurringinmorethanthenumberofexpectedcasesinacommunityANS: BMortality statistics refer to the number of individuals who have died over a specificperiod.Morbidity statistics show the prevalence of specific illness in the population at aparticular time. Data regarding disease within a geographic region, or in greater thanexpected numbers in a community, may be extrapolated from analyzing the morbiditystatistics.DIF: Cognitive Level: Remembering REF: p. 3 TOP: Nursing Process: PlanningMSC: Client Needs: Health Promotion and Maintenance7.The nurse should assess which age group for suicide ideation since suicide in whichage group is the third leading cause of death?a.Preschoolersb.Youngschoolagec.Middleschoolaged.LateschoolageandadolescentsANS: DSuicide is the third leading cause of death in children ages 10 to 19 years; therefore,the age group should be late school age and adolescents. Suicide is not one of theleading causes of death for preschool and young or middle school-aged children.DIF: Cognitive Level: Understanding REF: p. 6TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

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8.Parents of a hospitalized toddler ask the nurse,“Whatis meant by family-centeredcare?”The nurse should respond with which statement?a.Family-centeredcarereducestheeffectofculturaldiversityonthefamily.b.Family-centeredcareencouragesfamilydependenceonthehealthcaresystem.c.Family-centeredcarerecognizesthatthefamilyistheconstantinachild’slife.d.Family-centeredcareavoidsexpectingfamiliestobepartofthedecision-makingprocess.ANS: CThe three key components of family-centered care are respect, collaboration, andsupport. Family-centered care recognizes the family as the constant in thechild’slife.The family should be enabled and empowered to work with the health care system andis expected to be part of the decision-making process. The nurse should also supportthefamily’scultural diversity, not reduce its effect.DIF: Cognitive Level: Applying REF: p. 8TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance9.The nurse is describing clinical reasoning to a group of nursing students. Which ismost descriptive of clinical reasoning?a.Purposefulandgoaldirectedb.Asimpledevelopmentalprocessc.Basedondeliberateandirrationalthoughtd.AssistsindividualsinguessingwhatismostappropriateANS: AClinical reasoning is a complex developmental process based on rational anddeliberate thought. When thinking is clear, precise, accurate, relevant, consistent, andfair, a logical connection develops between the elements of thought and the problemat hand.DIF: Cognitive Level: Applying REF: p. 12TOP: Integrated Process: Teaching/LearningMSC: Client Needs: Health Promotion and Maintenance10.Evidence-based practice (EBP), a decision-making model, is best described aswhich?a.Usinginformationintextbookstoguidecareb.Combiningknowledgewithclinicalexperienceandintuition

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c.Usingaprofessionalcodeofethicsasameansfordecisionmakingd.Gatheringallevidencethatappliestothechild’shealthandfamilysituationANS: BEBP helps focus on measurable outcomes; the use of demonstrated, effectiveinterventions; and questioning what is the best approach. EBP involves decisionmaking based on data, not all evidence on a particular situation, and involves the latestavailable data. Nurses can use textbooks to determine areas of concern and potentialinvolvement.DIF: Cognitive Level: Remembering REF: p. 11 TOP: Nursing Process: PlanningMSC: Client Needs: Safe and Effective Care Environment11.Which best describes signs and symptoms as part of a nursing diagnosis?a.Descriptionofpotentialriskfactorsb.Identificationofactualhealthproblemsc.Humanresponsetostateofillnessorhealthd.CuesandclustersderivedfrompatientassessmentANS: DSigns and symptoms are the cues and clusters of defining characteristics that arederived from a patient assessment and indicate actual health problems. The first partof the nursing diagnosis is the problem statement, also known as the human responseto the state of illness or health. The identification of actual health problems may bepart of the medical diagnosis. The nursing diagnosis is based on the human responseto these problems. The human response is therefore a component of the nursingdiagnostic statement. Potential risk factors are used to identify nursing care needs toavoid the development of an actual health problem when a potential one exists.DIF: Cognitive Level: Understanding REF: p. 13TOP: Integrated Process: Communication and DocumentationMSC: Client Needs: Safe and Effective Care Environment12.The nurse is talking to a group of parents of school-age children at an after-schoolprogram about childhood health problems. Which statement should the nurse includein the teaching?a.Childhoodobesityisthemostcommonnutritionalproblemamongchildren.b.Immunizationratesarethesameamongchildrenofdifferentracesandethnicity.

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c.Dentalcariesisnotaproblemcommonlyseeninchildrensincetheintroductionoffluoridad.Mentalhealthproblemsaretypicallynotseeninschool-agechildrenbutmaybediagnosedANS: AWhen teaching parents of school-age children about childhood health problems, thenurse should include information about childhood obesity because it is the mostcommon problem among children and is associated with type 2 diabetes. Teachingparents about ways to prevent obesity is important to include. Immunization ratesdiffer depending on thechild’srace and ethnicity; dental caries continues to be acommon chronic disease in childhood; and mental health problems are seen inchildren as young as school age, not just in adolescents.DIF: Cognitive Level: Applying REF: p. 3TOP: Integrated Process: Teaching/LearningMSC: Client Needs: Health Promotion and Maintenance13.The nurse is planning care for a hospitalized preschool-aged child. Which shouldthe nurse plan to ensure atraumatic care?a.Limitexplanationofproceduresbecausethechildispreschoolaged.b.Askthatallfamilymembersleavetheroomwhenperformingprocedures.c.Allowthechildtochoosethetypeofjuicetodrinkwiththeadministrationoforalmedicatid.ExplainthatEMLAcreamcannotbeusedforthemorninglabdrawbecausethereisnottimeffective.ANS: CThe overriding goal in providing atraumatic care is first, do no harm. Allowing thechild a choice of juice to drink when taking oral medications provides the child with asense of control. The preschool child should be prepared before procedures, solimiting explanations of procedures would increase anxiety. The family should beallowed to stay with the child during procedures, minimizing stress.Lidocaine/prilocaine (EMLA) cream is a topical local anesthetic. The nurse shouldplan to use the prescribed cream in time for morning laboratory draws to minimizepain.DIF: Cognitive Level: Applying REF: pp. 8-9 TOP: Nursing Process: PlanningMSC: Client Needs: Health Promotion and Maintenance14.Which situation denotes a nontherapeutic nurse–patient–family relationship?a.Thenurseisplanningtoreadafavoritefairytaletoapatient.

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b.Duringshiftreport,thenurseiscriticizingparentsfornotvisitingtheirchild.c.Thenurseisdiscussingwithafellownursetheemotionaldrawtoacertainpatient.d.Thenurseisworkingwithafamilytofindwaystodecreasethefamily’sdependenceonheproviders.ANS: BCriticizing parents for not visiting in shift report is nontherapeutic and shows anunderinvolvement with the parents. Reading a fairy tale is a therapeutic and ageappropriate action. Discussing feelings of an emotional draw with a fellow nurse istherapeutic and shows a willingness to understand feelings. Working with parents todecrease dependence on health care providers is therapeutic and helps to empower thefamily.DIF: Cognitive Level: Analyzing REF: p. 9 TOP: Integrated Process: CaringMSC: Client Needs: Psychosocial Integrity15.The nurse is aware that which age group is at risk for childhood injury because ofthe cognitive characteristic of magical and egocentric thinking?a.Preschoolb.Youngschoolagec.Middleschoolaged.AdolescentANS: APreschool children have the cognitive characteristic of magical and egocentricthinking, meaning they are unable to comprehend danger to self or others. Young andmiddle school-aged children have transitional cognitive processes, and they mayattempt dangerous acts without detailed planning but recognize danger to themselvesor others. Adolescents have formal operational cognitive processes and arepreoccupied with abstract thinking.DIF: Cognitive Level: Understanding REF: p. 4TOP: Nursing Process: AssessmentMSC: Client Needs: Safe and Effective Care Environment16.The school nurse is assessing children for risk factors related to childhood injuries.Which child has the most risk factors related to childhood injury?a.Female,multiplesiblings,stablehomelifeb.Male,highactivitylevel,stressfulhomelife

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c.Male,eventempered,historyofpreviousinjuriesd.Female,reactsnegativelytonewsituations,noseriouspreviousinjuriesANS: BBoys have a preponderance for injuries over girls because of a difference inbehavioral characteristics, a high activity temperament is associated with risk-takingbehaviors, and stress predisposes children to increased risk taking and self-destructivebehaviors. Therefore, a male child with a high activity level and living in a stressfulenvironment has the highest number of risk factors. A girl with several siblings and astable home life is low risk. A boy with previous injuries has two risk factors, but aneven temper is not a risk factor for injuries. A girl who reacts negatively to newsituations but has no previous serious illnesses has only one risk factor.DIF: Cognitive Level: Analyzing REF: p. 4TOP: Nursing Process: AssessmentMSC: Client Needs: Safe and Effective Care Environment17.The school nurse is evaluating the number of school-age children classified asobese. The nurse recognizes that the percentile of body mass index that classifies achild as obese is greater than which?a.50thpercentileb.75thpercentilec.80thpercentiled.95thpercentileANS: DObesity in children and adolescents is defined as a body mass index at or greater thanthe 95th percentile for youth of the same age and gender.DIF: Cognitive Level: Remembering REF: p. 3 TOP: Nursing Process: EvaluationMSC: Client Needs: Health Promotion and Maintenance18.The nurse is teaching parents about the types of behaviors children exhibit whenliving with chronic violence. Which statement made by the parents indicates furtherteaching is needed?a.“Weshouldwatchforaggressiveplay.”b.“Ourchildmayshowlastingsymptomsofstress.”c.“Weknowthatourchildwillshowcaringbehaviors.”

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d.“Ourchildmayhavedifficultyconcentratinginschool.”ANS: CThe statement that the child will show caring behaviors needs further teaching.Children living with chronic violence may exhibit behaviors such as difficultyconcentrating in school, memory impairment, aggressive play, uncaring behaviors,and lasting symptoms of stress.DIF: Cognitive Level: Applying REF: p. 6TOP: Integrated Process: Teaching/LearningMSC: Client Needs: Health Promotion and Maintenance19.The nurse is evaluating research studies according to the GRADE criteria and hasdetermined the quality of evidence on the subject is moderate. Which type of evidencedoes this determination indicate?a.Strongevidencefromunbiasedobservationalstudiesb.Evidencefromrandomizedclinicaltrialsshowedinconsistentresultsc.Consistentevidencefromwell-performedrandomizedclinicaltrialsd.EvidenceforatleastonecriticaloutcomefromrandomizedclinicaltrialshadseriousflawsANS: BEvidence from randomized clinical trials with important limitations indicates that theevidence is of moderate quality. Strong evidence from unbiased observational studiesand consistent evidence from well-performed randomized clinical trials indicates highquality. Evidence for at least one critical outcome from randomized clinical trials thathas serious flaws indicates low quality.DIF: Cognitive Level: Remembering REF: p. 12 TOP: Nursing Process: EvaluationMSC: Client Needs: Safe and Effective Care Environment20.An adolescent patient wants to make decisions about treatment options, along withhis parents. Which moral value is the nurse displaying when supporting the adolescentto make decisions?a.Justiceb.Autonomyc.Beneficenced.NonmaleficenceANS: B

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Autonomy is thepatient’sright to be self-governing. The adolescent is trying to beautonomous, so the nurse is supporting this value. Justice is the concept of fairness.Beneficence is the obligation to promote thepatient’swell-being. Nonmaleficence isthe obligation to minimize or prevent harm.DIF: Cognitive Level: Analyzing REF: p. 11 TOP: Nursing Process: EvaluationMSC: Client Needs: Health Promotion and Maintenance21.The nurse manager is compiling a report for a hospital committee on the quality ofnursing-sensitive indicators for a nursing unit. Which does the nurse manager includein the report?a.Theaverageageofthenursesontheunitb.Thesalaryrangesforthenursesontheunitc.Theeducationandcertificationofthenursesontheunitd.ThenumberofnurseswhohaveappliedbutwerenothiredfortheunitANS: CNursing-sensitive indicators reflect the structure, process, and outcomes of nursingcare. For example, the number of nursing staff, the skill level of the nursing staff, andthe education and certification of nursing staff indicate the structure of nursing care.The average age of the nurses, salary range, and number of nurses who have appliedbut were not hired for the unit are not nursing-sensitive indicators.DIF: Cognitive Level: Applying REF: p. 15TOP: Integrated Process: Communication and DocumentationMSC: Client Needs: Safe and Effective Care EnvironmentMULTIPLE RESPONSE1.Which responsibilities are included in the pediatricnurse’spromotion of the healthand well-being of children?(Select all that apply.)a.Promotingdiseasepreventionb.Providingfinancialassistancec.Providingsupportandcounselingd.Establishinglifelongfriendshipse.Establishingatherapeuticrelationshipf.ParticipatinginethicaldecisionmakingANS: A, C, E, F

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The pediatricnurse’srole includes promoting disease prevention, providing supportand counseling, establishing a therapeutic relationship, and participating in ethicaldecision making; a pediatric nurse does not need to establish lifelong friendships orprovide financial assistance to children and their families. Boundaries should be setand clear.DIF: Cognitive Level: Applying REF: pp. 9-11 TOP: Nursing Process: PlanningMSC: Client Needs: Health Promotion and Maintenance2.The nurse is conducting a teaching session for parents on nutrition. Whichcharacteristics of families should the nurse consider that can cause families to strugglein providing adequate nutrition?(Select all that apply.)a.Homelessnessb.Lowerincomec.Migrantstatusd.Workingparentse.SingleparentstatusANS: A, B, CFamilies that struggle with lower incomes, homelessness, and migrant status generallylack the resources to provide their children with adequate food intake, nutritious foodssuch as fresh fruits and vegetables, and appropriate protein intake. Working parentsand single parent status do not mean the families will struggle to provide adequatenutrition.DIF: Cognitive Level: Applying REF: p. 2TOP: Integrated Process: Teaching/LearningMSC: Client Needs: Health Promotion and Maintenance3.The nurse is preparing to complete documentation on apatient’schart. Whichshould be included in documentation of nursing care?(Select all that apply.)a.Reassessmentsb.Incidentreportsc.Initialassessmentsd.Nursingcareprovidede.Patient’sresponseofcareprovidedANS: A, C, D, E

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Thepatient’smedical record should include: initial assessments, reassessments,nursing care provided, and thepatient’sresponse of care provided. Incident reports arenot documented in thepatient’schart.DIF: Cognitive Level: Applying REF: p. 14TOP: Integrated Process: Communication and DocumentationMSC: Client Needs: Safe and Effective Care Environment4.Which actions by the nurse demonstrate overinvolvement with patients and theirfamilies?(Select all that apply.)a.Buyingclothesforthepatientsb.Showingfavoritismtowardapatientc.Focusingontechnicalaspectsofcared.Spendingoff-dutytimewithpatientsandfamiliese.AskingquestionsiffamiliesarenotparticipatingincareANS: A, B, DActions that show overinvolvement include buying clothes for patients, showingfavoritism toward a patient, and spending off-duty time with patients and families.Focusing on technical aspects of care is an action that indicates underinvolvement,and asking questions if families are not participating in care indicates a positiveaction.DIF: Cognitive Level: Analyzing REF: pp. 9-10 TOP: Integrated Process: CaringMSC: Client Needs: Health Promotion and Maintenance5.Which are included in the evaluation step of the nursing process?(Select all thatapply.)a.Determinationiftheoutcomehasbeenmetb.Ascertainingiftheplanrequiresmodificationc.Establishprioritiesandselectingexpectedpatientgoalsd.Selectingalternativeinterventionsiftheoutcomehasnotbeenmete.DeterminingifariskoractualdysfunctionalhealthproblemexistsANS: A, B, DEvaluation is the last step in the nursing process. The nurse gathers, sorts, andanalyzes data to determine whether (1) the established outcome has been met, (2) thenursing interventions were appropriate, (3) the plan requires modification, or (4) other

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alternatives should be considered. Establishing priorities and selecting expectedpatient goals are done in the outcomes identification stage. Determining if a risk oractual dysfunctional health problem exists is done in the diagnosis stage of the nursingprocess.DIF: Cognitive Level: Understanding REF: p. 14 TOP: Nursing Process: EvaluationMSC: Client Needs: Health Promotion and Maintenance6.Which should the nurse teach to parents regarding oral health of children?(Selectall that apply.)a.Fluoridatedwatershouldbeused.b.Earlychildhoodcariesisapreventabledisease.c.Dentalcariesisararechronicdiseaseofchildhood.d.Dentalhygieneshouldbeginwiththefirsttootheruption.e.Childhoodcariesdoesnothappenuntilafter2yearsofage.ANS: A, B, DOral health instructions to parents of children should include use of fluoridated waterand dental hygiene beginning with the first tooth eruption. In addition, early childhoodcaries is a preventable disease and should be included in the teaching session. Dentalcaries is a common, not rare, chronic disease of childhood. Childhood caries maybegin before the first birthday.DIF: Cognitive Level: Applying REF: p. 2TOP: Integrated Process: Teaching/LearningMSC: Client Needs: Health Promotion and Maintenance7.The school nurse is explaining to older school children that obesity increases therisk for which disorders?(Select all that apply.)a.Asthmab.Hypertensionc.Dyslipidemiad.Irritableboweldiseasee.AlteredglucosemetabolismANS: B, C, E

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Overweight youth have increased risk for a cluster of cardiovascular factors thatinclude hypertension, altered glucose metabolism, and dyslipidemia. Irritable boweldisease and asthma are not linked to obesity.DIF: Cognitive Level: Applying REF: p. 3TOP: Integrated Process: Teaching/LearningMSC: Client Needs: Health Promotion and Maintenance8.The nurse is reviewing theHealthy People 2020leading health indicators for a childhealth promotion program. Which are included in the leading healthindicators?(Select all that apply.)a.Decreasetobaccouse.b.Improveimmunizationrates.c.Reduceincidencesofcancer.d.Increaseaccesstohealthcare.e.Decreasethenumberofeatingdisorders.ANS: A, B, DTheHealthy People 2020leading health indicators provide a framework foridentifying essential components for child health promotion programs designed toprevent future health problems in ournation’schildren. Some of the leading healthindicators include decreasing tobacco use, improving immunization rates, andincreasing access to health care. Reducing the incidence of cancer and decreasing thenumber of eating disorders are not on the list as leading health indicators.DIF: Cognitive Level: Analyzing REF: p. 2 TOP: Nursing Process: EvaluationMSC: Client Needs: Health Promotion and Maintenance9.Which actions by the nurse demonstrate clinical reasoning?(Select all that apply.)a.Basingdecisionsonintuitionb.Consideringalternativeactionc.Usingformalandinformalthinkingtogatherdatad.Givingdeliberatethoughttoapatient’sprobleme.DevelopinganoutcomefocusedonoptimumpatientcareANS: B, C, D, EClinical reasoning is a cognitive process that uses formal and informal thinking togather and analyze patient data, evaluate the significance of the information, and

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consider alternative actions. Clinical reasoning is a complex developmental processbased on rational and deliberate thought and developing an outcome focused onoptimum patient care. Clinical reasoning is based on the scientific method of inquiry;it is not based solely on intuition.DIF: Cognitive Level: Applying REF: p. 12 TOP: Nursing Process: EvaluationMSC: Client Needs: Safe and Effective Care EnvironmentCOMPLETION1.The nurse is determining if a newborn is classified in the low birth weight (LBW)category of less than 2500 g. Thenewborn’sweight is 5 lb, 4 oz. What is thenewborn’sweight in grams? Record your answer in a whole number.__________________ANS:2386Convert the 4 oz to a decimal by dividing 4 by 16 = 0.25. Use 5.25 lb and divide by2.2 to get 2.386 kg. Multiply by 1000 to convert to grams = 2386.DIF: Cognitive Level: Applying REF: p. 3TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and MaintenanceMATCHINGThe nursing process is a method of problem identification and problem solving thatdescribes what the nurse actually does. Match each step of the nursing process withits definition.a.Assessmentb.Diagnosisc.Outcomesidentificationd.Planninge.Implementationf.Evaluation1.Problem identification2.Expected patient goals3.Purposeful collection of data4.Development of a care plan5.Determines if the outcome was met6.Interventions are put into action

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1. ANS: B DIF: Cognitive Level: Understanding REF: p. 13TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance2. ANS: C DIF: Cognitive Level: Understanding REF: p. 13TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance3. ANS: A DIF: Cognitive Level: Understanding REF: p. 13TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance4. ANS: D DIF: Cognitive Level: Understanding REF: p. 13TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance5. ANS: F DIF: Cognitive Level: Understanding REF: p. 14TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance6. ANS: E DIF: Cognitive Level: Understanding REF: p. 14TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and MaintenanceEthical dilemmas arise when competing moral considerations underlie variousalternatives. Match each competing moral value with its definition.a.Autonomyb.Nonmaleficencec.Beneficenced.Justice7.The obligation to promote thepatient’swell-being8.The obligation to minimize or prevent harm9.Thepatient’sright to be self-governing10.The concept of fairness7. ANS: C DIF: Cognitive Level: Understanding REF: p. 11TOP: Integrated Process: Caring MSC: Client Needs: Health Promotion and Maintenance8. ANS: B DIF: Cognitive Level: Understanding REF: p. 11TOP: Integrated Process: Caring MSC: Client Needs: Health Promotion and Maintenance9. ANS: A DIF: Cognitive Level: Understanding REF: p. 11TOP: Integrated Process: Caring MSC: Client Needs: Health Promotion and Maintenance10. ANS: D DIF: Cognitive Level: Understanding REF: p. 11TOP: Integrated Process: Caring MSC: Client Needs: Health Promotion and Maintenance02: Social, Cultural, Religious, and FamilyInfluences on Child Health Promotion

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Chapter 02: Social, Cultural, Religious, and Family Influences on Child HealthPromotionMULTIPLE CHOICE1.Children are taught the values of their culture through observation and feedbackrelative to their own behavior. In teaching a class on cultural competence, the nurseshould be aware that which factor may be culturally determined?a.Ethnicityb.Racialvariationc.Statusd.GeographicboundariesANS: CStatus is culturally determined and varies according to each culture. Some culturesascribe higher status to age or socioeconomic position. Social roles also are influencedby the culture. Ethnicity is an affiliation of a set of persons who share a uniquecultural, social, and linguistic heritage. It is one component of culture. Race andculture are two distinct attributes. Whereas racial grouping describes transmissibletraits, culture is determined by the pattern of assumptions, beliefs, and practices thatunconsciously frames or guides the outlook and decisions of a group of people.Cultural development may be limited by geographic boundaries, but the boundariesare not culturally determined.DIF: Cognitive Level: Analyzing REF: p. 39TOP: Integrated Process: Teaching/LearningMSC: Client Needs: Psychosocial Integrity2.The nurse is aware that ifpatients’different cultures are implied to be inferior, theemotional attitude the nurse is displaying is what?a.Acculturationb.Ethnocentrismc.Culturalshockd.CulturalsensitivityANS: BEthnocentrism is the belief thatone’sway of living and behaving is the best way. Thisincludes the emotional attitude that the values, beliefs, and perceptions ofone’sethnic

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group are superior to those of others. Acculturation is the gradual changes that areproduced in a culture by the influence of another culture that cause one or bothcultures to become more similar. The minority culture is forced to learn the majorityculture to survive. Cultural shock is the helpless feeling and state of disorientation feltby an outsider attempting to adapt to a different culture group. Cultural sensitivity, acomponent of culturally competent care, is an awareness of cultural similarities anddifferences.DIF: Cognitive Level: Understanding REF: p. 35 TOP: Integrated Process: CaringMSC: Client Needs: Psychosocial Integrity3.Which term best describes the sharing of common characteristics that differentiatesone group from other groups in a society?a.Raceb.Culturec.Ethnicityd.SuperiorityANS: CEthnicity is a classification aimed at grouping individuals who consider themselves, orare considered by others, to share common characteristics that differentiate them fromthe other collectivities in a society, and from which they develop their distinctivecultural behavior. Race is a term that groups together people by their outward physicalappearance. Culture is a pattern of assumptions, beliefs, and practices thatunconsciously frames or guides the outlook and decisions of a group of people. Aculture is composed of individuals who share a set of values, beliefs, and practicesthat serve as a frame of reference for individual perception and judgments. Superiorityis the state or quality of being superior; it does not apply to ethnicity.DIF: Cognitive Level: Understanding REF: p. 39TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity4.After the family, which has the greatest influence on providing continuity betweengenerations?a.Raceb.Schoolc.Socialclass

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d.GovernmentANS: BSchools convey a tremendous amount of culture from the older members to theyounger members of society. They prepare children to carry out the traditional socialroles that will be expected of them as adults. Race is defined as a division ofhumankind possessing traits that are transmissible by descent and are sufficient tocharacterize race as a distinct human type; although race may have an influence onchildrearing practices, its role is not as significant as that of schools. Social classrefers to thefamily’seconomic and educational levels. The social class of a familymay change between generations. The government establishes parameters forchildren, including amount of schooling, but this is usually at a local level. The schoolculture has the most significant influence on continuity besides family.DIF: Cognitive Level: Remembering REF: p. 33TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity5.The nurse is planning care for a patient with a different ethnic background. Whichshould be an appropriate goal?a.Adapt,asnecessary,ethnicpracticestohealthneeds.b.Attempt,inanonjudgmentalway,tochangeethnicbeliefs.c.Encouragecontinuationofethnicpracticesinthehospitalsetting.d.Strivetokeepethnicbackgroundfrominfluencinghealthneeds.ANS: AWhenever possible, nurses should facilitate the integration of ethnic practices intohealth care provision. The ethnic background is part of the individual; it should bedifficult to eliminate the influence of ethnic background. The ethnic practices need tobe evaluated within the context of the health care setting to determine whether theyare conflicting.DIF: Cognitive Level: Applying REF: p. 34 TOP: Integrated Process: CaringMSC: Client Needs: Psychosocial Integrity6.The nurse discovers welts on the back of a Vietnamese child during a home healthvisit. Thechild’smother says she has rubbed the edge of a coin on herchild’soiledskin. The nurse should recognize this as what?a.Childabuseb.Culturalpracticetoridthebodyofdisease

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c.Culturalpracticetotreatenuresisortempertantrumsd.ChilddisciplinemeasurecommonintheVietnamesecultureANS: BThis is descriptive of coining. The welts are created by repeatedly rubbing a coin onthechild’soiled skin. The mother is attempting to rid thechild’sbody of disease.Coining is a cultural healing practice. Coining is not specific for enuresis or tempertantrums. This is not child abuse or discipline.DIF: Cognitive Level: Understanding REF: p. 41TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity7.A Hispanic toddler has pneumonia. The nurse notices that the parent consistentlyfeeds the child only the broth that comes on the clear liquid tray. Food items, such asJell-O, Popsicles, and juices, are left. Which statement best explains this?a.Theparentistryingtofeedthechildonlywhatthechildlikesmost.b.Hispanicsbelievethe“evileye”enterswhenapersongetscold.c.Theparentistryingtorestorenormalbalancethroughappropriate“hot”remedies.d.Hispanicsbelieveaninnateenergycalledchiisstrengthenedbyeatingsoup.ANS: CIn several cultures, including Filipino, Chinese, Arabic, and Hispanic, hot and colddescribe certain properties completely unrelated to temperature. Respiratoryconditions such as pneumonia are“cold”conditions and are treated with“hot”foods.The child may like broth but is unlikely to always prefer it to Jell-O, Popsicles, andjuice. The evil eye applies to a state of imbalance of health, not curative actions.Chinese individuals, not Hispanic individuals, believe in chi as an innate energy.DIF: Cognitive Level: Applying REF: p. 40TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity8.How is family systems theory best described?a.Thefamilyisviewedasthesumofindividualmembers.b.Achangeinonefamilymembercannotcreateachangeinothermembers.c.Individualfamilymembersarereadilyidentifiedasthesourceofaproblem.d.Whenthefamilysystemisdisrupted,changecanoccuratanypointinthesystem.ANS: D

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Family systems theory describes an interactional model. Any change in one memberwill create change in others. Although the family is the sum of the individualmembers, family systems theory focuses on the number of dyad interactions that canoccur. The interactions, not the individual members, are considered to be the problem.DIF: Cognitive Level: Analyzing REF: p. 18TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity9.Which family theory is described as a series of tasks for the family throughout itslife span?a.Exchangetheoryb.Developmentaltheoryc.Structural-functionaltheoryd.SymbolicinteractionaltheoryANS: BIn developmental systems theory, the family is described as a small group, asemiclosed system of personalities that interact with the larger cultural system.Changes do not occur in one part of the family without changes in others. Exchangetheory assumes that humans, families, and groups seek rewarding statuses so thatrewards are maximized while costs are minimized. Structural-functional theory statesthat the family performs at least one societal function while also meeting familyneeds. Symbolic interactional theory describes the family as a unit of interactingpersons with each occupying a position within the family.DIF: Cognitive Level: Remembering REF: p. 19TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity10.Which family theory explains how families react to stressful events and suggestsfactors that promote adaptation to these events?a.Interactionaltheoryb.Familystresstheoryc.Erikson’spsychosocialtheoryd.DevelopmentalsystemstheoryANS: BFamily 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

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positive and negative, are cumulative and affect the family. Adaptation requires achange in family structure or interaction. Interactional theory is not a family theory.Interactions are the basis of general systems theory.Erikson’stheory applies toindividual growth and development, not families. Developmental systems theory is anoutgrowth ofDuvall’stheory. The family is described as a small group, a semiclosedsystem of personalities that interact with the larger cultural system. Changes do notoccur in one part of the family without changes in others.DIF: Cognitive Level: Remembering REF: p. 19TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity11.Which type of family should the nurse recognize when the paternal grandmother,the parents, and two minor children live together?a.Blendedb.Nuclearc.Extendedd.BinuclearANS: CAn extended family contains at least one parent, one or more children, and one ormore members (related or unrelated) other than a parent or sibling. A blended familycontains at least one stepparent, stepsibling, or half-sibling. A nuclear family consistsof two parents and their children. No other relatives or nonrelatives are present in thehousehold. In binuclear families, parents continue the parenting role while terminatingthe spousal unit. For example, when joint custody is assigned by the court, each parenthas equal rights and responsibilities for the minor child or children.DIF: Cognitive Level: Remembering REF: pp. 20-21TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity12.Which type of family should the nurse recognize when a mother, her children, anda stepfather live together?a.Traditionalnuclearb.Blendedc.Extendedd.BinuclearANS: B

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A blended family contains at least one stepparent, stepsibling, or half-sibling. Atraditional nuclear family consists of a married couple and their biologic children. Noother relatives or nonrelatives are present in the household. An extended familycontains at least one parent, one or more children, and one or more members (relatedor unrelated) other than a parent or sibling. In binuclear families, parents continue theparenting role while terminating the spousal unit. For example, when joint custody isassigned by the court, each parent has equal rights and responsibilities for the minorchild or children.DIF: Cognitive Level: Remembering REF: p. 20TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity13.Which is an accurate description of homosexual (or gay-lesbian) families?a.Anurturingenvironmentislacking.b.Thechildrenbecomehomosexualliketheirparents.c.Thestabilityneededtoraisehealthychildrenislacking.d.Thequalityofparentingisequivalenttothatofnongayparents.ANS: DAlthough gay or lesbian families may be different from heterosexual families, theenvironment can be as healthy as any other. Lacking a nurturing environment andstability is reflective on the parents and family, not the type of family. There is littleevidence to support that children become homosexual like their parents.DIF: Cognitive Level: Understanding REF: pp. 21-22TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity14.The nurse is teaching a group of new nursing graduates about identifiable qualitiesof strong families that help them function effectively. Which quality should beincluded in the teaching?a.Lackofcongruenceamongfamilymembersb.Clearsetoffamilyvalues,rules,andbeliefsc.Adoptionofonecopingstrategythatalwayspromotespositivefunctioningindealingwithd.SenseofcommitmenttowardgrowthofindividualfamilymembersasopposedtothatofthANS: BA clear set of family rules, values, and beliefs that establish expectations aboutacceptable and desired behavior is one of the qualities of strong families that help

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them function effectively. Strong families have a sense of congruence among familymembers regarding the value and importance of assigning time and energy to meetneeds. Varied coping strategies are used by strong families. The sense of commitmentis toward the growth and well-being of individual family members, as well as thefamily unit.DIF: Cognitive Level: Applying REF: p. 22TOP: Integrated Process: Teaching/LearningMSC: Client Needs: Psychosocial Integrity15.When assessing a family, the nurse determines that the parents exert little or nocontrol over their children. This style of parenting is called which?a.Permissiveb.Dictatorialc.Democraticd.AuthoritarianANS: APermissive parents avoid imposing their own standards of conduct and allow theirchildren to regulate their own activity as much as possible. The parents exert little orno control over theirchildren’sactions. Dictatorial or authoritarian parents attempt tocontrol theirchildren’sbehavior and attitudes through unquestioned mandates. Theyestablish rules and regulations or standards of conduct that they expect to be followedrigidly and unquestioningly. Democratic parents combine permissive and dictatorialstyles. They direct theirchildren’sbehavior and attitudes by emphasizing the reasonsfor rules and negatively reinforcing deviations. They respect theirchildren’sindividual natures.DIF: Cognitive Level: Remembering REF: p. 24TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity16.When discussing discipline with the mother of a 4-year-old child, which should thenurse include?a.Parentalcontrolshouldbeconsistent.b.Withdrawalofloveandapprovaliseffectiveatthisage.c.Childrenasyoungas4yearsrarelyneedtobedisciplined.d.Oneshouldexpectrulestobefollowedrigidlyandunquestioningly.

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ANS: AFor effective discipline, parents must be consistent and must follow through withagreed-on actions. Withdrawal of love and approval is never appropriate or effective.The 4-year-old child will test limits and may misbehave. Children of this age do notrespond to verbal reasoning. Realistic goals should be set for this age group.Discipline is necessary to reinforce these goals. Discipline strategies should beappropriate to thechild’sage and temperament and the severity of the misbehavior.Following rules rigidly and unquestioningly is beyond the developmental capabilitiesof a 4-year-old child.DIF: Cognitive Level: Applying REF: p. 24TOP: Integrated Process: Teaching/LearningMSC: Client Needs: Psychosocial Integrity17.Which is a consequence of the physical punishment of children, such as spanking?a.Thepsychologicimpactisusuallyminimal.b.Thechild’sdevelopmentofreasoningincreases.c.Childrenrarelybecomeaccustomedtospanking.d.Misbehaviorislikelytooccurwhenparentsarenotpresent.ANS: DThrough 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 becausethey have not learned to behave well for their own sake but rather out of fear ofpunishment. Spanking can cause severe physical and psychologic injury and interferewith effective parent–child interaction. The use of corporal punishment may interferewith thechild’sdevelopment of moral reasoning. Children do become accustomed tospanking, requiring more severe corporal punishment each time.DIF: Cognitive Level: Analyzing REF: p. 26TOP: Integrated Process: Teaching/LearningMSC: Client Needs: Psychosocial Integrity18.The parents of a young child ask the nurse for suggestions about discipline. Whendiscussing the use of time-outs, which should the nurse include?a.Sendthechildtohisorherroomifthechildhasone.b.Ageneralruleforlengthoftimeis1hourperyearofage.c.Selectanareathatissafeandnonstimulating,suchasahallway.

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d.Ifthechildcries,refuses,orismoredisruptive,tryanotherapproach.ANS: CThe area must be nonstimulating and safe. The child becomes bored in thisenvironment and then changes behavior to rejoin activities. Thechild’sroom mayhave toys and activities that negate the effect of being separated from the family. Thegeneral rule is 1 minute per year of age. An hour per year is excessive. When the childcries, refuses, or is more disruptive, the time-out does not start; the time-out beginswhen the child quiets.DIF: Cognitive Level: Remembering REF: p. 26TOP: Integrated Process: Teaching/LearningMSC: Client Needs: Psychosocial Integrity19.A 3-year-old child was adopted immediately after birth. The parents have justasked the nurse how they should tell the child that she is adopted. Which guidelineconcerning adoption should the nurse use in planning a response?a.Itisbesttowaituntilthechildasksaboutit.b.Thebesttimetotellthechildisbetweentheagesof7and10years.c.Itisnotnecessarytotellachildwhowasadoptedsoyoung.d.Tellingthechildisanimportantaspectoftheirparentalresponsibilities.ANS: DIt is important for the parents not to withhold information about the adoption from thechild. It is an essential component of thechild’sidentity. There is no recommendedbest time to tell children. It is believed that children should be told young enough sothey do not remember a time when they did not know. It should be done before thechildren enter school to prevent third parties from telling the children before theparents have had the opportunity.DIF: Cognitive Level: Analyzing REF: p. 27TOP: Integrated Process: Teaching/LearningMSC: Client Needs: Psychosocial Integrity20.Children may believe that they are responsible for theirparents’divorce andinterpret the separation as punishment. At which age is this most likely to occur?a.1yearb.4years

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c.8yearsd.13yearsANS: BPreschool-age children are most likely to blame themselves for the divorce. A 4-year-old child will fear abandonment and express bewilderment regarding all humanrelationships. A 4-year-old child has magical thinking and believes his or her actionscause consequences, such as divorce. For infants, divorce may increase theirirritability and interfere with the attachment process, but they are too young to feelresponsibility. School-age children will have feelings of deprivation, including theloss of a parent, attention, money, and a secure future. Adolescents are able todisengage themselves from the parental conflict.DIF: Cognitive Level: Analyzing REF: p. 29 TOP: Nursing Process: PlanningMSC: Client Needs: Psychosocial Integrity21.A parent of a school-age child tells the school nurse that the parents are goingthrough a divorce. The child has not been doing well in school and sometimes hastrouble sleeping. The nurse should recognize this as what?a.Indicativeofmaladjustmentb.Acommonreactiontodivorcec.Suggestiveofalackofadequateparentingd.AnunusualresponsethatindicatesaneedforreferralANS: BParental divorce affects school-age children in many ways. In addition to difficultiesin school, they often have profound sadness, depression, fear, insecurity, frequentcrying, loss of appetite, and sleep disorders. Thechild’sresponses are commonreactions of school-age children to parental divorce.DIF: Cognitive Level: Applying REF: p. 29TOP: Integrated Process: Teaching/LearningMSC: Client Needs: Psychosocial Integrity22.A mother brings 6-month-old Eric to the clinic for a well-baby checkup. Shecomments,“Iwant to go back to work, but Idon’twant Eric to suffer becauseI’llhave less time withhim.”Which is thenurse’smost appropriate answer?a.“I’msurehe’llbefineifyougetagoodbabysitter.”

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b.“YouwillneedtostayhomeuntilEricstartsschool.”c.“Let’stalkaboutthechildcareoptionsthatwillbebestforEric.”d.“YoushouldgobacktoworksoEricwillgetusedtobeingwithothers.”ANS: CAsking the mother about child care options is an open-ended statement that will assistthe mother in exploring her concerns about what is best for both her and Eric. Theother three answers are directive; they do not address the effect that her working willhave on Eric.DIF: Cognitive Level: Applying REF: p. 32TOP: Integrated Process: Teaching/LearningMSC: Client Needs: Psychosocial Integrity23.A foster parent is talking to the nurse about the health care needs for the child whohas been placed in theparent’scare. Which statement best describes the health careneeds of foster children?a.Fosterchildrenalwayscomefromabusivehouseholdsandareemotionallyfragile.b.Fosterchildrentendtohaveahigherthannormalincidenceofacuteandchronichealthproc.Fosterchildrenareusuallybornprematurelyandrequiretechnologicallyadvancedhealthcd.Fosterchildrenwillnotstayinthehomeforanextendedperiod,sohealthcareneedsarenoemotionalfulfillment.ANS: BChildren who are placed in foster care have a higher incidence of acute and chronichealth problems and may experience feelings of isolation and confusion; therefore,they should be monitored closely. Foster children do not always come from abusivehouseholds and may or may not be emotionally fragile; not all foster children are bornprematurely or require technically advanced health care; and foster children may stayin the home for extended periods, so their health care needs require attention.DIF: Cognitive Level: Applying REF: p. 32TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity24.The nurse is planning to counsel family members as a group to assess thefamily’sgroup dynamics. Which theoretic family model is the nurse using as a framework?a.Feministtheoryb.Familystresstheory

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c.Familysystemstheoryd.DevelopmentaltheoryANS: CIn family systems theory, the family is viewed as a system that continually interactswith its members and the environment. The emphasis is on the interaction between themembers; a change in one family member creates a change in other members, whichin turn results in a new change in the original member. Assessing thefamily’sgroupdynamics is an example of using this theory as a framework. Family stress theoryexplains how families react to stressful events and suggests factors that promoteadaptation to stress. Developmental theory addresses family change over time usingDuvall’sfamily life cycle stages based on the predictable changes in thefamily’sstructure, function, and roles, with the age of the oldest child as the marker for stagetransition. Feminist theories assume that privilege and power are inequitablydistributed based upon gender, race, and class.DIF: Cognitive Level: Applying REF: p. 18 TOP: Nursing Process: PlanningMSC: Client Needs: Psychosocial Integrity25.The nurse is reviewing the importance of role learning for children. The nurseunderstands thatchildren’sroles are primarily shaped by which members?a.Peersb.Parentsc.Siblingsd.GrandparentsANS: BChildren’sroles are shaped primarily by the parents, who apply direct or indirectpressures to induce or force children into the desired patterns of behavior or directtheir efforts toward modification of the role responses of the child on a mutuallyacceptable basis.DIF: Cognitive Level: Analyzing REF: pp. 22-23TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity26.The nurse is caring for an adolescent hospitalized for asthma. The adolescentbelongs to a large family. The nurse recognizes that the adolescent is likely to relate towhich group?a.Peers

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b.Parentsc.Siblingsd.TeachersANS: AAdolescents from a large family are more peer oriented than family oriented.Adolescents in small families identify more strongly with their parents and rely moreon them for advice.DIF: Cognitive Level: Understanding REF: p. 23 TOP: Integrated Process: CaringMSC: Client Needs: Psychosocial Integrity27.The nurse is explaining different parenting styles to a group of parents. The nurseexplains that an authoritative parenting style can lead to which child behavior?a.Shynessb.Self-reliancec.Submissivenessd.Self-consciousnessANS: BChildren raised by parents with an authoritative parenting style tend to have high self-esteem and are self-reliant, assertive, inquisitive, content, and highly interactive withother children. Children raised by parents with an authoritarian parenting style tend tobe sensitive, shy, self-conscious, retiring, and submissive.DIF: Cognitive Level: Applying REF: p. 24TOP: Integrated Process: Teaching/LearningMSC: Client Needs: Psychosocial Integrity28.Parents of a preschool child ask the nurse,“Shouldwe set rules for our child aspart of a disciplineplan?”Which is an accurate response by the nurse?a.“Itisbesttodelaythepunishmentifaruleisbroken.”b.“Thechildistooyoungforrules.Atthisage,unrestrictedfreedomisbest.”c.“Itisbesttosettherulesandreasonwiththechildwhentherulesarebroken.”d.“SetclearandreasonablerulesandexpectthesamebehaviorregardlessofthecircumstancANS: DNurses can help parents establish realistic and concrete“rules.”The clearer the limitsthat are set and the more consistently they are enforced, the less need there is for

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