Child Health Nursing Partnering With Children & Families, 3rd Edition by Jane W. Ball -Test Bank

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WITH ANSWERS

Child Health Nursing Partnering With Children & Families, 3rd Edition by Jane W. Ball -Test Bank

Ball, Child Health Nursing, 3/E
Chapter 2

Question 1

Type: MCSA

A seven-year-old client tells you, Grandpa, Mommy, Daddy, and my brother live at my house. The nurse identifies this family type as a(n):

1. Extended family.
2. Traditional nuclear family.
3. Binuclear family.
4. Heterosexual cohabitating family.

Correct Answer: 1

Rationale 1: An extended family contains a parent or a couple who share the house with their children and another adult relative.

Rationale 2: The traditional nuclear family consists of both biological parents, the children, and no other relatives or persons living in the household.

Rationale 3: A binuclear family includes divorced parents who have joint custody of their biological children; the children alternate spending varying amounts of time in the home of each parent.

Rationale 4: A heterosexual cohabitating family consists of a heterosexual couple, with or without children, living together outside of marriage.

Global Rationale:

 

Cognitive Level: Applying

Client Need:

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 2-2

 

Question 2

Type: MCSA

During assessment of a childs biological family history, it is especially important that the nurse asking the mother for information uses the term childs father instead of your husband in the situation of a:

1. Traditional nuclear family.
2. Two-income nuclear family.
3. Traditional extended family.
4. Heterosexual cohabitating family.

Correct Answer: 4

Rationale 1: In the traditional nuclear family, the childs father is the same person as the mothers husband.

Rationale 2: The two-income nuclear family consists of children living with both biological parents where both parents are employed. The childs father is the same person as the mothers husband.

Rationale 3: In the traditional extended family, the childs father is the same person as the mothers husband. In this family group, there will be other adult relatives living as a member of the family.

Rationale 4: The couple in a heterosexual cohabitating family is not married, so no husband exists; the nurse should be asking about the childs father.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need:

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 2-2

 

Question 3

Type: MCSA

The community health nurse is assessing several families for various strengths and needs in regard to afterschool and backup child care arrangements. The family type that typically will benefit most from this assessment and subsequent interventions is the:

1. Traditional nuclear family.
2. Extended family.
3. Binuclear family.
4. Single-parent family.

Correct Answer: 4

Rationale 1: The traditional nuclear family has two adults who can share in the care and nurturing of its children.

Rationale 2: The extended family generally has two or more adults who can share in the care and nurturing of its children.

Rationale 3: The binuclear family generally has at least two adults who can share in the care and nurturing of its children.

Rationale 4: The single-parent family most typically lacks social, emotional, and financial resources. Nursing considerations for such families should include referrals to options that will enable the parent to fulfill work commitments while providing the child with access to resources that can support the childs growth and development.

Global Rationale:

 

Cognitive Level: Applying

Client Need:

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 2-2

 

Question 4

Type: MCSA

The community health nurse is making an initial visit to a family. The most effective and efficient way for the nurse to assess the parenting style in use is to:

1. Ask the parents, What rule is hardest for your child to obey?
2. Ask the children what happens when they break the rules.
3. Ask the parents, How often do you hug or kiss your children?
4. Observe the parent interacting with the child for five minutes.

Correct Answer: 2

Rationale 1: Learning about rules is less helpful than is an explanation of enforcement efforts and success.

Rationale 2: Parental styles are assessed while the family explains how it handles situations that require limit setting.

Rationale 3: Learning about how the parents express affection will not provide adequate information about parenting styles.

Rationale 4: While under short term observation, parental behavior may not be accurate. A less complete picture of parenting style is obtained during a brief artificial observation.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need:

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 2-3

 

Question 5

Type: MCSA

The nurse is working on parenting skills with a group of mothers. Which style of parenting tends to produce adolescents who tend to be self-reliant and socially competent?

1. Authoritarian
2. Permissive
3. Indifferent
4. Authoritative

Correct Answer: 4

Rationale 1: Children in the authoritarian parenting family are denied the opportunity to develop some skills in the areas of self-direction, communication, and negotiation.

Rationale 2: Under the permissive parenting style, children do not learn the socially acceptable limits of behaviors.

Rationale 3: The indifferent parenting style results in children who often exhibit destructive behaviors and delinquency.

Rationale 4: The authoritative parenting style is one that results in positive outcomes for the behavior and learning of children. Nurses have observed that children from homes using this parental style more frequently have personalities manifesting self-reliance, self-control, and social competence. These parents should be praised for using the preferred approach.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need:

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 2-3

 

Question 6

Type: MCSA

The nurse is working with a mother of three children on parenting skills. The nurse demonstrates a strategy that uses reward to increase positive behavior. This strategy is called:

1. Time-out.
2. Experiencing consequences of misbehavior.
3. Reasoning.
4. Behavior modification.

Correct Answer: 4

Rationale 1: Time-out involves removing the child to an isolated, toy-free area for a short period of time to demonstrate that there are consequences of misbehavior.

Rationale 2: Experiencing consequences allows the child to learn that misbehavior results in negative experiences, such as losing privileges.

Rationale 3: Reasoning involves discussions about behaviors to help the child understand positive and negative behaviors.

Rationale 4: Behavior modification reinforces good behavior by giving rewards for desired behaviors.

Global Rationale:

 

Cognitive Level: Applying

Client Need:

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 2-3

 

Question 7

Type: MCSA

The nurse is assigned to a child in a spica cast for a fractured femur suffered in an automobile accident. The childs teenage brother was driving the car, which was totaled. The nurse learns that the father lost his job three weeks ago and that the mother has just accepted a temporary waitress job. An appropriate diagnosis for this family is:

1. Interrupted Family Processes related to a child with significant disability requiring alteration in family functioning.
2. Risk for Caregiver Role Strain related to a child with a newly acquired disability and the associated financial burden.
3. Impaired Social Interaction (parent and child) related to the lack of family or respite support.
4. Compromised Family Coping related to multiple simultaneous stressors.

Correct Answer: 4

Rationale 1: The spica cast might require alteration in family functioning; however, the situation describes no signs and symptoms to indicate this. In addition, fractures generally are not considered a significant long-term disability.

Rationale 2: The need for a spica cast is not considered a newly acquired disability. Nothing about the situation describes caregiver role strain.

Rationale 3: Lack of family members and lack of respite support were not mentioned in the scenario.

Rationale 4: The situation describes multiple changes, or stressors, in the familys situation that compromise family coping skills.

Global Rationale:

 

Cognitive Level: Applying

Client Need:

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Diagnosis

Learning Outcome: 2-4

 

Question 8

Type: MCSA

Several children arrived at the emergency department accompanied only by their fathers. The nurse knows that the father who legally may sign emergency medical consent for treatment is:

1. The non-biologic one from the heterosexual cohabitating family.
2. The divorced one from the binuclear family.
3. The divorced one when the single-parent mother has custody.
4. The stepfather from the blended or reconstituted family.

Correct Answer: 2

Rationale 1: The non-biologic father from the heterosexual cohabitating family does not have legal authority to seek emergency medical care for the child.

Rationale 2: The divorced father from the binuclear family may sign informed consent because he has equal legal rights with the mother under joint custody arrangements.

Rationale 3: When the single-parent mother has custody, the divorced non-biologic father does not have legal authority to seek emergency medical care for the child.

Rationale 4: The non-biologic stepfather from the blended or reconstituted family does not have legal authority to seek emergency medical care for the child.

Global Rationale:

 

Cognitive Level: Applying

Client Need:

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 2-5

 

Question 9

Type: MCSA

The camp nurse is assessing a group of children attending summer camp. Which child will be most likely to have problems perceiving a sense of belonging?

1. The child whose parents divorced recently
2. The child recently placed into foster care
3. The child whose mother remarried and who gained a stepparent recently
4. The child adopted as an infant

Correct Answer: 2

Rationale 1: Children whose parents divorce often fear abandonment.

Rationale 2: Children in foster care are more likely to have problems perceiving a sense of belonging.

Rationale 3: Children who gain a stepparent might have problems trusting the new parent.

Rationale 4: Infants who are adopted at birth can have minimal problems with acceptance when parents follow pre-adoption counseling about disclosure.

Global Rationale:

 

Cognitive Level: Applying

Client Need:

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 2-5

 

Question 10

Type: MCSA

A new pediatric hospital will open soon. While planning nursing care, the hospital administration is considering two models of providing health care: family-focused care and family-centered care. The best example of a nursing action in the family-centered care approach would be when the nurse:

1. Assumes the role of an expert professional to direct the health care.
2. Encourages the parents to stay with and comfort the child during an invasive procedure.
3. Assumes the role of a healthcare authority and intervenes for the child and family as a unit.
4. Tells the family what must be done for the familys health.

Correct Answer: 2

Rationale 1: Directing the care as a professional is an example of family-focused care. In family-focused care, the health care worker assumes the role of professional expert while missing the multiple contributions the family brings to the health care meeting.

Rationale 2: Encouraging parents to be present during procedures exemplifies family-centered care. The benefit of employing the family-centered care philosophy is that the priorities and needs as seen by the family are addressed as a partnership between a family and a nurse develops.

Rationale 3: Intervening for the family as a health care authority is an example of family-focused care. In family-focused care, the health care worker assumes the role of professional expert while missing the multiple contributions the family brings to the health care meeting.

Rationale 4: Telling the family what should be done is family-focused care. In family-focused care, the health care worker assumes the role of professional expert. Though a good way of providing pediatric health care, those participating in this type of care will miss contributions that the family brings to the health care meeting, as in family-centered care.

Global Rationale:

 

Cognitive Level: Applying

Client Need:

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 2-6

 

Question 11

Type: MCSA

A nurse is working with the family of a pediatric client. The nurse is planning to obtain an accurate family assessment. The initial step would be to:

1. Select the most relevant family assessment tool.
2. Establish a trusting relationship with the family.
3. Focus primarily on the mother, learning her greatest concern.
4. Observe the family in the home setting, since this step always proves indispensable.

Correct Answer: 2

Rationale 1: There is benefit when the tool used matches the familys strengths and resources; however, selecting the most relevant family assessment tool is not the initial step in obtaining a family assessment.

Rationale 2: Establishment of a trusting relationship between the family and the nurse is the essential preliminary step in obtaining an accurate family assessment.

Rationale 3: Focusing primarily on the mother while learning her greatest concern is counterproductive and prevents the nurse from acknowledging multiple perceptions held by the familys members.

Rationale 4: Observing the family in the home setting is recommended only in some cases.

Global Rationale:

 

Cognitive Level: Applying

Client Need:

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 2-8

 

Question 12

Type: SEQ

The nurse working in a family-centered hospital sees families at all stages of the family life cycle. Place each of the following families along the continuum of the family life cycle, beginning with the earliest stage and proceeding to the last stage.

Standard Text: Click and drag the options below to move them up or down.

Choice 1. The husband who retired from his job four years ago. He has been widowed six months.

Choice 2. Newlyweds

Choice 3. Family with three children, ages 17, 13, and 9

Choice 4. Family taking their first child home from the birth hospital

Choice 5. Family with grown children. Both parents hold full time jobs.

Choice 6. Family whose oldest child will start kindergarten next year and whose third child will be born shortly

Correct Answer: 2,4,6,3,5,1

Rationale 1: Stage VIIIFamily in retirement and old age. This is the final stage of the family life cycle.

Rationale 2: Stage I Beginning family. This is the first stage of the family life cycle.

Rationale 3: Stage VFamilies with teenagers

Rationale 4: Stage IIChildbearing family

Rationale 5: Stage VIIMiddle-aged parents

Rationale 6: Stage III Families with preschool children

Global Rationale:

 

Cognitive Level: Analyzing

Client Need:

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 26

 

Question 13

Type: MCSA

A pediatric clinic serves several children who were adopted. The clinic nurse recognizes that the adopted child who is most likely to blame himself for being given away by the biologic parents is the:

1. Adopted child entering high school.
2. Child under three who was adopted as an infant.
3. Preschooler whose skin color is different from the adopted parents.
4. Child entering kindergarten.

Correct Answer: 4

Rationale 1: The adolescent often fantasizes about his biological parents.

Rationale 2: This child does not understand adoption and doesnt recognize himself as different from his parents.

Rationale 3: This child recognizes differences in appearance and enjoys hearing his adoption story.

Rationale 4: The five-year-old child is most likely to shoulder the blame for being given up by the biologic parents.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need:

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 2-5

 

Question 14

Type: MCMA

While performing a family assessment, the nurse identifies which symptoms associated with dysfunctional family coping strategies?

Standard Text: Select all that apply.

1. Father acknowledges an addiction to alcohol.
2. The mother is a stay-at-home mother, and the father works two jobs to make ends meet.
3. The family has deep religious beliefs.
4. The father makes all of the decisions for the family, and the mother is compliant with the fathers decisions.
5. Direct, open communication among family members is observed.

Correct Answer: 1,4

Rationale 1: Drug and alcohol addictions are symptoms of dysfunctional coping strategies.

Rationale 2: This is a family decision related to family finances and preferences and is not a dysfunctional coping strategy.

Rationale 3: Spiritual supports are associated with functioning coping.

Rationale 4: This could be a symptom of extreme dominance and submission.

Rationale 5: This is a functional coping strategy.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need:

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 2-4

 

Question 15

Type: MCSA

As a component of the family assessment, the family assists the nurse in developing an ecomap. Prior to beginning the ecomap, the nurse explains that the ecomap:

1. Provides information about the family structure including family life events, health, and illness.
2. Illustrates family relationships and interactions with community activities including school, parental jobs, and childrens activities.
3. Is a short questionnaire of five questions that measures family growth, affection, and resolve.
4. Is a family assessment that consists of three categories of information about the familys strengths and problems.

Correct Answer: 2

Rationale 1: Information of this type is called a genogram.

Rationale 2: This is the description of the ecogram.

Rationale 3: The five-item questionnaire measuring family growth, affection, resolve, adaptability, and partnership is a Family Apgar.

Rationale 4: This describes a Calgary Family Assessment Model.

Global Rationale:

 

Cognitive Level: Applying

Client Need:

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 2-7

 

 

Ball, Child Health Nursing, 3/E
Chapter 16

Question 1

Type: MCSA

The nurse in the long-term care clinic is reviewing the charts of a group of children being seen for follow-up visits in the pediatric clinic. The nurse recognizes that chronic limitations might result from which diagnosis?

1. Pneumonia from Haemophilus influenzae virus
2. Respiratory syncytial virus
3. Streptococcus pneumoniae, a gram-positive diplococcus
4. Congenital heart defect

Correct Answer: 4

Rationale 1: Pneumonia is not a chronic limitation.

Rationale 2: Respiratory syncytial virus is a serious infection caused by a virus that affects infants. It does not result in permanent disability.

Rationale 3: Streptococcus pneumoniae, a gram-positive diplococcus, is treatable and will not cause chronic limitation.

Rationale 4: A congenital heart defect can leave a child with a permanent chronic condition.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need:

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 16-1

 

Question 2

Type: MCSA

All of the following children are inpatients on the pediatric unit. Which child is likely to be left with a developmental disability?

1. An 18-month-old admitted with a diagnosis of near drowning
2. A school-age child newly diagnosed with type 1 diabetes mellitus
3. A toddler with sepsis
4. A two-year-old child with a fractured femur

Correct Answer: 1

Rationale 1: Near drowning indicates a period of time when the child was underwater and not breathing; near drowning can leave a child with a permanent chronic condition.

Rationale 2: Diabetes is a chronic disease but does not lead to developmental disabilities.

Rationale 3: Sepsis is treatable and will not result in a developmental disability.

Rationale 4: A fractured femur is limiting to a child but will not leave the child with a chronic, limiting condition.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need:

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 16-1

 

Question 3

Type: MCSA

The school nurse completes an assessment of a six-year-old child to determine the services this child will need in the classroom. The child needs respiratory support with oxygen. The child requires enteral tube feedings and intravenous medications during the school day. With these needs, the school nurse evaluates the child to be:

1. Medically fragile.
2. Developmentally delayed.
3. Mentally retarded.
4. Socially withdrawn.

Correct Answer: 1

Rationale 1: A child who is dependent on medical devices for survival or prevention of further disability is medically fragile. A child who is medically fragile is not necessarily developmentally delayed, mentally retarded, or socially withdrawn.

Rationale 2: There is no behavioral evidence to support a finding that the child is developmentally delayed.

Rationale 3: There is no evidence in the stem that suggests that this child is mentally retarded.

Rationale 4: The child who is socially withdrawn does not need any special equipment in the classroom.

Global Rationale:

 

Cognitive Level: Applying

Client Need:

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 16-2

 

Question 4

Type: MCMA

The nurse is partnering with the family of a hospitalized premature infant who suffered an intraventricular brain hemorrhage. After three months in the neonatal intensive care unit (NICU), the infant is being discharged. Which activities will the nurse suggest to the family to help stimulate the infants development?

Standard Text: Select all that apply.

1. Using a day care for stimulation
2. Discouraging sibling interaction
3. Holding and rocking the infant
4. Interacting face to face
5. Talking softly and singing to the infant

Correct Answer: 3,4,5

Rationale 1: A premature infant might not have a mature immune system; therefore, day care might present an infection issue. The needs of this child might not be met in a day care setting with many children.

Rationale 2: Sibling interaction is important and should be encouraged.

Rationale 3: Holding and rocking the infant stimulates the infants sense of motion, facilitating parent-infant bonding.

Rationale 4: Interacting face to face stimulates the infants sense of vision, facilitating parent-infant bonding.

Rationale 5: Talking softly and singing to the infant are activities that stimulate the infants senses of hearing, touch, and motion, facilitating parent-infant bonding.

Global Rationale:

 

Cognitive Level: Applying

Client Need:

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 16-3

 

Question 5

Type: MCSA

The nurse can instruct parents to expect children in which age group to begin to assume more independent responsibility for their own management of a chronic condition, such as blood glucose monitoring, insulin administration, intermittent self-catheterization, and appropriate inhaler use?

1. Preschoolers
2. School-age children
3. Adolescents
4. Toddlers

Correct Answer: 2

Rationale 1: Preschoolers do not have the cognitive and psychomotor skills for these tasks.

Rationale 2: School-age children are developing a sense of industry and can begin assuming responsibility for self-care.

Rationale 3: Adolescents should already be well accomplished at self-care.

Rationale 4: Toddlers do not have the cognitive and psychomotor skills for these tasks.

Global Rationale:

 

Cognitive Level: Applying

Client Need:

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 16-3

 

Question 6

Type: MCSA

The nurse is working in an adolescent medical clinic. When comparing adolescents in the clinic who have chronic conditions with their peers, the nurse would expect chronically ill adolescents to have:

1. More concern for their parents.
2. A decreased concern about their appearance.
3. An altered body image.
4. Higher self-esteem.

Correct Answer: 3

Rationale 1: As adolescents develop a sense of identity, they are focused on themselves and the present.

Rationale 2: Adolescents with chronic conditions will have a heightened concern about their appearance.

Rationale 3: Adolescents with chronic conditions might have inaccurate assessments of their body image.

Rationale 4: Adolescents with chronic conditions have low self-esteem when comparing their bodies with those of their peers.

Global Rationale:

 

Cognitive Level: Applying

Client Need:

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 16-3

 

Question 7

Type: MCSA

The nurse is working with the parents of a child with a chronic condition. The nurse concludes that the parents caregiver burden might become overwhelming when the mother states which of the following?

1. My mother moved in and helps us with the care of our family.
2. I chose to quit my job to be home with my child, and my husband helps in the evening when he can.
3. I have to care for my child day and night, which leaves little time for me.
4. Our health insurer sent us a rejection letter for my childs brand-name medication, and we must fill out forms to get the generic.

Correct Answer: 3

Rationale 1: The familys pitching in to help indicates family support.

Rationale 2: The mother chose to care for the child and receives help from the husband.

Rationale 3: No respite time from caregiving responsibilities could lead to overwhelming caregiver burden.

Rationale 4: Substituting generic for brand-name medications will not result in caregiver burden.

Global Rationale:

 

Cognitive Level: Applying

Client Need:

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 16-4

 

Question 8

Type: MCMA

In working with parents of children with chronic diseases, the nurse is concerned with helping the parents to protect themselves from compassion fatigue. The nurse would encourage which activities?

Standard Text: Select all that apply.

1. Fostering social relationships
2. Exercising
3. Developing a hobby
4. Moving away
5. Sleeping more than 9 hours per 24-hour period

Correct Answer: 1,2,3

Rationale 1: Fostering social relationships contributes to social and mental rest and restoration.

Rationale 2: Exercising contributes to physical restoration.

Rationale 3: Developing a hobby contributes to physical, spiritual, social, and mental rest and restoration.

Rationale 4: Moving away is an avoidance behavior that does not address exhaustion from overwhelming caregiving responsibilities.

Rationale 5: Sleeping more than the body requires is an avoidance behavior.

Global Rationale:

 

Cognitive Level: Applying

Client Need:

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 16-5

 

Question 9

Type: MCSA

The nurse is working with a child with a chronic condition. The nurse observes that over time, the parents have experienced a pattern of periodic grieving alternating with denial. The nurse would recognize this pattern as:

1. Pathologic grieving.
2. Compassion fatigue.
3. Chronic sorrow.
4. Dysfunctional parenting.

Correct Answer: 3

Rationale 1: Pathologic grieving results when persons do not move through the stages of grief to resolution.

Rationale 2: Compassion fatigue is experienced by caregivers as their ability to feel compassion is exhausted.

Rationale 3: Parents experience chronic sorrow as they grieve when their child does not meet developmental milestones or participate in activities of normal children. The time between periods of grieving might be times of parental denial, which allows the family to function.

Rationale 4: Dysfunctional parenting involves inadequately meeting the needs of children.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need:

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 16-4

 

Question 10

Type: MCSA

The nurse is conducting a nursing assessment of the parent and child with severe cerebral palsy during a routine clinic visit. Which of the following is important for the nurse to include on this assessment?

1. Measuring the urine output
2. Measuring the childs head circumference
3. Observing the parent-child relationship
4. Observing how the child interacts during play

Correct Answer: 3

Rationale 1: Measuring urine output is not important unless there are problems with the bladder.

Rationale 2: Measuring the childs head circumference is not an important assessment at this time.

Rationale 3: Observing the parent-child relationship is important to the success of health supervision for both the child and parents.

Rationale 4: Playtime is not important during this time.

Global Rationale:

 

Cognitive Level: Applying

Client Need:

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 16-4

 

Question 11

Type: MCSA

The nurse is conducting an educational program for parents of children with chronic conditions. Which statement by a parent requires additional nursing interventions?

1. I know my child will get better and not have to take any more medication.
2. I know my child will need assistance with activities of daily living.
3. I know my child may need specialized education.
4. I know my child will have to stay on a special diet.

Correct Answer: 1

Rationale 1: Chronic conditions might require lifetime dependence on medication.

Rationale 2: Children with chronic conditions typically need assistance with daily living activities.

Rationale 3: A child with a chronic condition may require specialized education.

Rationale 4: Depending on the diagnosis, children with chronic conditions might require a special diet.

Global Rationale:

 

Cognitive Level: Applying

Client Need:

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 16-4

 

Question 12

Type: MCSA

An adolescent has recently been diagnosed with type 1 diabetes mellitus and is on dietary restrictions and daily insulin. The nurse is teaching the adolescents family members about the disease and treatment. The nurse will warn the family that the adolescent, upon returning to school, may:

1. Recognize that there is no difference between her and her classmates.
2. Not experience social stigma.
3. Acknowledge her condition to her classmates.
4. Not adhere to dietary recommendations.

Correct Answer: 4

Rationale 1: Adolescents might recognize differences between themselves and others, such as appearance, abilities, and social skills, for the first time.

Rationale 2: Adolescents might experience social stigma when their classmates find out about a health condition.

Rationale 3: Adolescents will attempt to hide their health conditions from their classmates.

Rationale 4: Adolescents have poorer eating habits than all other age groups, and adolescents with diabetes may not adhere to necessary dietary restrictions.

Global Rationale:

 

Cognitive Level: Applying

Client Need:

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 16-6

 

Question 13

Type: MCMA

The nurse is working with a 20-year-old who is medically fragile. It is the policy of the clinic to only see patients from birth to 21 years of age. The nurse is responsible for assisting the individual and family to transition to adult health care. The nurse recognizes that the individual may face difficulties related to:

Standard Text: Select all that apply.

1. No longer qualifying for the states child health insurance program and becoming uninsured.
2. Wanting to start fresh with the new healthcare provider and refusing to allow transfer of their records to the new agency.
3. Adult clinics being unwilling to accept this chronically ill individual into their practice.
4. The parents choosing an adult clinic that is not the one the individual would like to attend.
5. Being unwilling to transition to the adult clinic due to the relationships they have with the pediatric clinic.

Correct Answer: 1,3,5

Rationale 1: Most states end their state insurance at the age of 21. Adults who are medically fragile are often unable to find an insurance carrier that will cover their health care needs.

Rationale 2: The individual and family will recognize that in order to get continuity of care, the new clinic will need information about past and current treatment.

Rationale 3: Many clinics are not accepting new patients or may accept new patients but are unwilling to accept a patient who is medically fragile.

Rationale 4: The parents and individual will usually decide together which adult clinic to attend.

Rationale 5: Patients and family members who have been attending a clinic for so many years are often reluctant to transition to another clinic.

Global Rationale:

 

Cognitive Level: Applying

Client Need:

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 16-6

 

Question 14

Type: MCSA

A family actively participates in school functions with all their children, one of whom is paraplegic and requires a wheelchair for mobility. The nurse evaluates this family to be working on the process of:

1. Stagnation.
2. Isolation.
3. Normalization.
4. Interaction.

Correct Answer: 3

Rationale 1: The family is not staying at home because one member cannot walk.

Rationale 2: The family is moving on to full participation in life.

Rationale 3: The family is normalizing their life with their children by their activities.

Rationale 4: The family is interacting with others through the process of normalization.

Global Rationale:

 

Cognitive Level: Applying

Client Need:

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 16-5

 

Question 15

Type: MCMA

After the infant is diagnosed as a child with a chronic health condition, the family is assigned a nurse working as a case manager. The nurse would explain that as a case manager, the nurses role will include:

Standard Text: Select all that apply.

1. Limiting the number of visits to the health care facility.
2. Preventing duplication of services.
3. Improving the quality of life for the child and parents.
4. Recognizing the equipment needs of the child and providing assistance with equipment acquisition.
5. Visiting the child in the home to assist with physical care.

Correct Answer: 2,3,4

Rationale 1: Although well managed care may reduce illnesses and thus visits to the health care facility, limiting visits is not a function of the case manager.

Rationale 2: Because many children who are chronically ill are seen by many doctors and clinics, there is often a duplication of services. Case managing coordinates between the various clinics and doctors to prevent duplication.

Rationale 3: Case managing has many modes of improving the quality of life for children and parents. By coordinating care, the child can often be seen by several physicians during the same visit, thus improving the quality of life.

Rationale 4: The case manager will assist the family in meeting the needs of the child, including helping with identifying and acquiring equipment necessary for caring for the child.

Rationale 5: The case manager does not provide direct patient care.

Global Rationale:

 

Cognitive Level: Applying

Client Need:

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 16-7

 

Question 16

Type: MCSA

The nurse works in a clinic for medically fragile children who require constant home care. The nurse has noticed that a high percentage of the families wind up divorcing. In an attempt to reduce the divorce rate among the parents, the nurse creates an educational session for parents of medically fragile children that focuses on the need for:

1. Communication.
2. Financial stability.
3. Meeting the childs physical needs.
4. The state laws that have relevance to the medically fragile child.

Correct Answer: 1

Rationale 1: Both partners need to be able to communicate honestly and frequently to maintain the marriage relationship.

Rationale 2: Finances will be a problem for the family as the cost of care of medically fragile child can be high. Nurses may refer to community resources but cannot solve all financial problems.

Rationale 3: The nurse will teach parents how to meet the childs physical needs on a one-to-one basis, not in a group session.

Rationale 4: This will not reduce the divorce rate.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need:

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 16-4

 

Question 17

Type: MCMA

The school nurse is reviewing the records of all incoming kindergarten students. The nurse recognizes that an individualized education plan (IEP) will be required for which children?

Standard Text: Select all that apply.

1. The child with diabetes controlled with insulin
2. The child with a casted arm due to a fracture
3. The child with a hearing deficit
4. The child with autism
5. The child with an IQ of 60

Correct Answer: 3,4,5

Rationale 1: This child may need an individual health plan but does not require an IEP.

Rationale 2: This is not a chronic problem and does not require an IEP.

Rationale 3: This child will need modification of the educational plan in order to be successful.

Rationale 4: The child diagnosed on the autism spectrum will have special educational needs that will be determined by the IEP.

Rationale 5: The child with an IQ of 60 is intellectually disabled and will require an individual education plan.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need:

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 16-6

 

Question 18

Type: MCSA

The nurse recommends to the family of a child with severe cerebral palsy that they enroll their child in hippotherapy. The nurse would explain that hippotherapy includes:

1. Water exercises to increase muscular strength.
2. Use of braces and walkers to support walking.
3. Dietary therapy to maintain a normal weight.
4. Horseback riding, or hippotherapy, improves posture and balance and allows the child to participate in a physical activity.

Correct Answer:

Rationale 1: Hippotherapy does not involve water exercises.

Rationale 2: Hippotherapy does not involve bracing and the use of walkers.

Rationale 3: Hippotherapy is not related to nutrition.

Rationale 4: True

Global Rationale:

 

Cognitive Level: Applying

Client Need:

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 16-5

 

Question 19

Type: MCSA

The mother of a 16-year-old child with multiple medical and developmental issues says to the nurse: There are times that I think about just walking out of the house and not coming back. Which would be an appropriate nursing diagnosis for this mother?

1. Caregiver role strain related to providing 24-hour care for a child with medical and developmental issues
2. Risk for injury (maternal) related to overwhelming demands of the medically fragile child
3. Knowledge deficit (maternal) nursing care of the child
4. Health seeking behaviors (maternal) related to interest in learning to care for her child

Correct Answer: 1

Rationale 1: This diagnosis describes the effect of this childs care on the mother.

Rationale 2: There is no indication of a risk for injury in the stem.

Rationale 3: This question does not indicate a lack of knowledge by the mother but frustration due to the daily demands of caring for her child.

Rationale 4: There is no indication in the stem that the mother wants to learn more about medical care for her child.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need:

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Diagnosis

Learning Outcome: 16-6

 

Question 20

Type: MCSA

The three-year-old child with cystic fibrosis has just been discharged from the hospital following a two-week stay due to a respiratory infection. The child has a post-discharge office visit the next day. During the office visit, the mother mentions that the child was toilet trained before hospitalization but now is having accidents. Which response by the nurse would be most appropriate?

1. This is probably a reaction to the antibiotics and will disappear when the antibiotics are finished.
2. Urinary incontinence is a common symptom of progression of cystic fibrosis. Be sure to notify the physician of this change.
3. The child may have a urinary tract infection and needs to be evaluated.
4. Children often regress after hospitalization. Be patient and remind him to go to the bathroom frequently.

Correct Answer: 4

Rationale 1: Antibiotic therapy does not cause incontinence.

Rationale 2: Urinary incontinence is not a symptom of cystic fibrosis.

Rationale 3: There are no symptoms of a UTI.

Rationale 4: Regression is a common response to hospitalization.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need:

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 16-3

 

Question 21

Type: MCSA

Shortly after birth, all newborns are tested for phenylketonuria. The test results are not available before mother and baby are discharged from the hospital. When the diagnosis of PKU is made, the most appropriate means of informing the parents would be:

1. Immediately in a phone call requesting a follow-up office visit
2. In a certified letter explaining the diagnosis and requesting the parents make a pediatric office appointment.
3. In a group meeting of all parents whose children tested positive for phenylketonuria during the last two months.
4. In person with the physician and both parents present.

Correct Answer: 4

Rationale 1: Providing the parents information of a chronic health problem of their newborn should not be done over the phone.

Rationale 2: This information should be provided to the parents in person.

Rationale 3: This information should be shared on a one-to-one basis.

Rationale 4: The appropriate environment allows for privacy and freedom from interruptions. The parents should be allowed other support people to be present as they request.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need:

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 16-4

 

Question 22

Type: MCMA

Following an automobile accident in which the child received a traumatic head injury, the child has been hospitalized for two weeks. The parents have just been informed that their four-month-old child will have long-term consequences due to the injury, including intellectual disability and cerebral palsy. The parents express anger at the diagnosis and project that anger on the nursing staff. The response by the nursing staff should include:

Standard Text: Select all that apply.

1. Referring the family to the hospital administrator.
2. Recognizing that the parents anger is a normal response to the news.
3. Continuing to provide physical and emotional care to the child and family.
4. Offering hospital resources to the parents in addition to continued nursing support.
5. Explaining to the family that you are sorry about their childs injury but suggest they transfer the child to another hospital for their own comfort.

Correct Answer: 2,3,4

Rationale 1: The hospital administrator will be unable to meet their needs or to calm their anger.

Rationale 2: Parents grieve for the loss of the perfect child. This is a normal reaction.

Rationale 3: The nursing staff will continue to provide physical and emotional care to the child and family.

Rationale 4: It is appropriate to offer the hospital chaplain and other mental health workers in addition to continued support from the nursing staff.

Rationale 5: This option is a resolution for the nursing staff but not for the parents.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need:

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 16-5

 

 

Ball, Child Health Nursing, 3/E
Chapter 36

Question 1

Type: MCSA

The nurse is examining a 12-month-old who was brought to the clinic for persistent diaper rash. The nurse finds perianal inflammation with bright red, scaly plaques and small papules. Satellite lesions are also present. This is most likely caused by which of the following?

1. Candida albicans (yeast)
2. Impetigo (staph)
3. Infrequent diapering
4. Urine and feces

Correct Answer: 1

Rationale 1: Candida albicans is frequently the underlying cause of severe diaper rash. When a primary or secondary infection with Candida albicans occurs, the rash has bright red, scaly plaques with sharp margins. Small papules and pustules might be seen, along with satellite lesions.

Rationale 2: Even though diaper dermatitis can be caused by impetigo, urine, feces, and infrequent diapering, the lesions and persistent characteristics are common for Candida.

Rationale 3: Infrequent diapering, along with urine and feces, can cause diaper dermatitis, but the persistence and characteristics of the lesions are common for Candida.

Rationale 4: Urine and feces can cause diaper dermatitis, but the persistence and characteristics of the lesions are common for Candida.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need:

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 36-2

 

Question 2

Type: MCSA

The school nurse is conducting pediculosis capitis (head lice) checks. Which finding would indicate a positive head check?

1. White, flaky particles throughout the entire scalp region
2. Lesions on the scalp that extend to the hairline or neck
3. Maculopapular lesions behind the ears
4. Silver/white sacs attached to the hair shafts in the occipital area

Correct Answer: 4

Rationale 1: Lice and nits must be distinguished from dandruff, which appears as white, flaky particles.

Rationale 2: Lesions might be present from itching, but the positive sign of head lice is evidence of nits.

Rationale 3: Lesions might be present from itching, but the positive sign of head lice is evidence of nits.

Rationale 4: Evidence of pediculosis capitis includes silver/white sacs (nits) that are attached to the hair shafts, frequently in the occiput area.

Global Rationale:

 

Cognitive Level: Applying

Client Need:

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 36-2

 

Question 3

Type: MCSA

The 10-year-old child is admitted to the hospital following an accident at school that resulted in a puncture wound of the abdomen. Two days after the injury, the child continues in the inflammation phase of healing. What would the nurse expect to see while changing the childs dressing and assessing the wound?

1. The wound is contracting, and the edges are growing together.
2. A blood clot has formed, sealing the wound.
3. Epithelial cells are growing into the wound.
4. The wound is pale and weepy.

Correct Answer: 2

Rationale 1: Wound contraction and inward movement of the wound edge occur during the reconstruction phase of wound healing.

Rationale 2: Clot formation to seal the wound with fibrin and trapped cells and platelets occurs during the inflammation phase of wound healing, in the first three to five days.

Rationale 3: Epithelial cells growing into the wound occurs in the reconstruction phase of wound healing.

Rationale 4: During the initial phase of healing, there is increased blood flow, giving the area an inflamed appearance.

Global Rationale:

 

Cognitive Level: Applying

Client Need:

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 36-3

 

Question 4

Type: MCMA

A child had an appendectomy and was discharged home at 48 hours postoperative. A week later the child is readmitted for delayed wound healing. Which causes of delayed wound healing will the nurse review prior to assessing the child?

Standard Text: Select all that apply.

1. Infection
2. Predisposing chronic condition, such as diabetes
3. Hypervolemia
4. Inadequate nutrition
5. Hypoxemia
6. Corticosteroid therapy

Correct Answer: 1,2,4,5,6

Rationale 1: Infection can affect healing and cause excessive scarring.

Rationale 2: Conditions such as diabetes affect circulating blood volume and are known to affect healing.

Rationale 3: Hypovolemia, not hypervolemia, would inhibit inflammation due to low circulating blood volume.

Rationale 4: Poor nutrition without proper protein and calorie intake will affect healing.

Rationale 5: Hypoxemia makes tissues susceptible to infection due to insufficient oxygenation.

Rationale 6: Corticosteroid therapy or other immunocompromising therapy will preve

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