Nursing Care Of Children Principles And Practice (James, Nursing Care of Children) 4th Edition By James -Test Bank

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Nursing Care Of Children Principles And Practice (James, Nursing Care of Children) 4th Edition By James -Test Bank

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Nursing Care Of Children Principles And Practice (James, Nursing Care of Children) 4th Edition By James -Test Bank

02: Family-Centered Nursing Care

 

Chapter 02: Family-Centered Nursing Care

 

Test Bank

 

MULTIPLE CHOICE

 

A nurse is teaching parents how to apply time-out as a disciplinary method for their 4 year old. Parents have understood the teaching if they state which formula correctly guides the use of

 

time-out?

 

 

Use the guideline of 1 minute per each year of the childs age.

 

Relate the length of the time-out to the severity of the behavior.

 

Never use time-out for a child younger than age 4 years.

 

Follow the time-out with a treat.

 

 

ANS: A

 

In time-out, the child is told to sit on a chair for a predetermined time, usually 1 minute per year of age. Relating time to a behavior is subjective and inappropriate when the child is very young. Time-out can be used with a toddler. Negative behavior should not be reinforced with a positive action.

 

DIF: Cognitive Level: Comprehension REF: p. 34

 

OBJ: Nursing Process Step: Evaluation MSC: Health Promotion and Maintenance

 

  1. What is the nurses best approach when an 8-year-old boy frequently causes a disruption in the playroom by taking toys from other children?

 

                                                                                                                                                                                                                                                                                                                                                                                                                         Exclude the child from the playroom.

 

                                                                                                                                                                                                                                                                                                                                                                                                                           Explain to the children in the playroom that he is very ill and should be allowed to have the toys.

 

                                                                                                                                                                                                                                                                                                                                                                                                                          Approach the child in his room and ask, Would you like it if the other children took your toys from y Approach the child in his room and state, I am concerned that you are taking the other childrens toy

                                                                                                                                                                                                                                                                                                                                                                                                                          me.

 

 

 

ANS: D

 

The nurse can focus on the behavior most effectively by using I rather than you messages. A you message criticizes the child and uses guilt in an attempt to change behavior. Banning the child from the playroom will not solve the problem. The problem is the childs behavior, not the place where the child exhibits it. Illness is not a reason for a child to be undisciplined. When the child recovers, the parents will have to deal with a child who is undisciplined and unruly. The child should not be made to feel guilty and to have his or her self-esteem attacked. DIF: Cognitive Level: Application REF: p. 34

 

OBJ: Nursing Process Step: Implementation MSC: Psychosocial Integrity

 

  1. Families that deal most effectively with stress have which behavior patterns?

 

 

Focus on family problems.

 

Feel weakened by stress.

 

Expect that some stress is normal.

 

Feel guilty when stress exists.

 

 

ANS: C

 

Healthy families recognize that some stress is normal in all families, focus on family strengths rather than on the problems, and know that stress is temporary and may be positive. Because some stress is normal in all families, there is no reason to feel guilty. Guilt only immobilizes the family and does not lead to a resolution of the stress. DIF: Cognitive Level: Comprehension REF: p. 25

 

OBJ: Nursing Process Step: Assessment MSC: Psychosocial Integrity

 

  1. Which family will most likely have the greatest difficulty in coping with an ill child?

 

 

A single-parent mother who has the support of her parents and siblings

 

Parents who have just moved to the area and are living in an apartment while they look for a house The family of a child who has had multiple hospitalizations related to asthma and has adequate relatio

nursing staff

 

A family in which there is a young child and four older married children who live in the area

 

 

ANS: B

 

Parents who are in a new environment will have increased stress related to their lack of a support system. If only one parent is available but has the support of her extended family, this will assist in her adjustment to the crisis. The family that has had positive experiences in the past with hospitalizations can draw from those experiences and feel confident about the current setting. For

 

 

the family with one younger child and four older married children who live in the area, the family has an extensive support system, which will assist the parents in adjusting to the crisis. DIF: Cognitive Level: Application REF: p. 27

 

OBJ: Nursing Process Step: Planning MSC: Psychosocial Integrity

 

  1. Which is the priority nursing intervention for the family of a child who has been admitted to the hospital?

 

Begin discharge teaching.

 

Identify and mobilize internal and external strengths.

 

Identify ways in which the family could have prevented their childs hospitalization.

 

Instruct the parents on normal growth and development.

 

 

ANS: B

 

Family interventions should be directed toward enhancing positive coping strategies and directing the family to appropriate resources. Although discharge teaching is begun as soon as possible, it is ineffective if trust has not been established with the parents or if the level of stress precludes learning. By identifying weaknesses instead of focusing on strengths, the familys anxiety and feelings of powerlessness or guilt may increase. Normal growth and development should be interwoven into teaching; however, teaching cannot take place until the parents have less stress and are open to information.

 

DIF: Cognitive Level: Application REF: p. 27

 

OBJ: Nursing Process Step: Implementation MSC: Psychosocial Integrity

 

  1. A nurse is planning culturally competent care for a child of Hispanic descent. Which characteristic found in a Hispanic family should the nurse include in the plan of care?

 

Stoicism

 

Close extended family

 

Docile children are considered weak

 

Very interested in health-promoting lifestyles

 

 

ANS: B

 

Most Mexican-American families are very close and it is not unusual for children to be surrounded by parents, siblings, grandparents, and godparents. It is important to respect this cultural characteristic and to see it as a strength, not a weakness. Although stoicism may be present in any family, Mexican-American families tend to be more expressive. Considering docile children as weak is a characteristic of American Indians. Although there is a trend for

 

 

everyone to embrace more health-promoting lifestyles, it is more prominent in Anglo-Americans.

 

DIF: Cognitive Level: Application REF: p. 28

 

OBJ: Nursing Process Step: Planning MSC: Psychosocial Integrity

 

While reviewing nursing documentation on dietary intake for a 7-year-old child of Asian descent, the nurse notes that he consistently refuses to eat the food on his tray. Which assumption

 

is most likely accurate?

 

 

He is a picky eater.

 

He needs less food because he is on bed rest.

 

He may have culturally related food preferences.

 

He is probably eating between meals and spoiling his appetite.

 

 

ANS: C

 

When cultural differences are noted, food preferences should always be obtained. A child will often not eat unfamiliar foods. Although the child may be a picky eater, the key point is that he is from a different culture. The foods he is being served may seem strange to him. Nutrition plays an important role in healing. Although the child expends less energy while on bed rest, he has increased needs for good nutrition. Although it should be determined whether the child is eating food the family has brought from home, it is more important to determine his food preferences. DIF: Cognitive Level: Application REF: p. 28

 

OBJ: Nursing Process Step: Assessment MSC: Psychosocial Integrity

 

  1. To resolve family conflict, it is necessary to have open communication, accurate perception of the problem, and a(n):

 

intact family structure.

 

arbitrator.

 

willingness to consider the view of others.

 

balance in personality types.

 

 

ANS: C

 

Without the willingness of the members of a group to consider the views of others, conflict resolution cannot take place. The structure of a family may affect their dynamics, but it is still possible to resolve conflict without an intact family structure if all the ingredients of conflict resolution are present. Conflicts can be resolved without the assistance of an arbitrator. Most families have diverse personality types among their members. This may make conflict resolution

 

 

more difficult; however, it should not impede it if the ingredients of conflict resolution are present.

 

DIF: Cognitive Level: Knowledge REF: p. 27

 

OBJ: Nursing Process Step: Implementation MSC: Psychosocial Integrity

 

  1. A nurse is planning a parenting class for expectant parents. Which statement is true about the characteristics of a healthy family?

 

The parents and children have rigid assignments for all the family tasks.

 

Young families assume total responsibility for the parenting tasks, refusing any assistance.

 

The family is overwhelmed by the significant changes that occur as a result of childbirth.

 

Adults agree on the majority of basic parenting principles.

 

 

ANS: D

 

A trait of a healthy family is that adults agree on the basic principles of parenting so that minimal discord exists. A significant stressor for families is lack of shared responsibility in the family. Lack of flexibility in parental tasks is likely to create stress and conflict. Admitting to and seeking help with problems, rather than refusing assistance, is a trait of a healthy family. Adjusting to the birth of a child is a significant change for a family. A sense of feeling overwhelmed by this change indicates that the family is not coping effectively. DIF: Cognitive Level: Comprehension REF: p. 25

 

OBJ: Nursing Process Step: Planning MSC: Psychosocial Integrity

 

  1. A nurse determines that a child consistently displays predictable behavior and is regular in performing daily habits. Which temperament is the child displaying?

 

Easy

 

Slow-to-warm-up

 

Difficult

 

Shy

 

 

ANS: A

 

Children with an easy temperament are even tempered, predictable, and regular in their habits. They react positively to new stimuli. A high activity level and adapting slowly to new stimuli are characteristics of a difficult temperament. The slow-to-warm-up temperament type prefers to be inactive and moody. Shyness is a personality type and not a characteristic of temperament. Being moody is a characteristic of a slow-to-warm up temperament. DIF: Cognitive Level: Analysis REF: p. 33

 

OBJ: Nursing Process Step: Assessment MSC: Psychosocial Integrity

 

 

The parent of a child who has had numerous hospitalizations asks the nurse for advice because her child has been having behavior problems at home and in school. In discussing

 

effective discipline, which is an essential component?

 

 

All children display some degree of acting out and this behavior is normal.

 

The child is manipulative and should have firmer limits set on her behavior.

 

Use positive reinforcement and encouragement to promote cooperation and the desired behaviors. Underlying reasons for rules should be given and the child should be allowed to decide on which rule

followed.

 

 

ANS: C

 

Using positive reinforcement and encouragement to promote cooperation and desired behaviors is one of the three essential components of effective discipline. Behavior problems should not be disregarded as normal. It would be incorrect to assume the child is being manipulative and should have firmer limits set on her behaviors. Providing the underlying reasons for rules and giving the child a choice concerning which rules to follow constitute a component of permissive parenting and are not considered an essential component of effective discipline. DIF: Cognitive Level: Comprehension REF: p. 33

 

OBJ: Nursing Process Step: Assessment MSC: Psychosocial Integrity

 

  1. A nurse assesses that parents discuss rules with their children when the children do not agree with the rules. Which style of parenting is being displayed?

 

Authoritarian

 

Authoritative

 

Permissive

 

Disciplinarian

 

 

ANS: B

 

A parent who discusses the rules with which children do not agree is using an authoritative parenting style. A parent who expects children to follow rules without questioning is using an authoritarian parenting style. A parent who does not consistently enforce rules and allows the child to decide whether he or she wishes to follow rules is using a permissive parenting style. A disciplinarian style would be similar to the authoritarian style. DIF: Cognitive Level: Analysis REF: p. 32

 

OBJ: Nursing Process Step: Assessment MSC: Psychosocial Integrity

 

Which should the nurse expect to be problematic for a family whose religious affiliation is

 

Jehovahs Witness?

 

 

Immunizations

 

Autopsy

 

Organ donation

 

Blood transfusion

 

 

ANS: D

 

Jehovahs Witness believers are opposed to blood transfusions. They may accept alternatives to transfusions, such as nonblood plasma expanders; they can make individual decisions about autopsy. Christian Science believers may seek exemption from immunizations. Believers in Islam are opposed to organ donation.

 

DIF: Cognitive Level: Comprehension REF: p. 29

 

OBJ: Nursing Process Step: Assessment MSC: Psychosocial Integrity

 

MULTIPLE RESPONSE

 

  1. The nurse is caring for a child from a Middle Eastern family. Which interventions should the nurse include in planning care? Select all that apply.

 

Include the father in the decision making.

 

Ask for a dietary consult to maintain religious dietary practices.

 

Plan for a male nurse to care for a female patient.

 

Ask the housekeeping staff to interpret if needed.

 

 

ANS: A, B

 

The man is typically the head of the household in Muslim families. So the father should be included in all decision making. Muslims do not eat pork and do not use alcohol. Many are vegetarians. The dietician should be consulted for dietary preferences. Muslim women often prefer a female healthcare provider because of laws of modesty; the female client should not be assigned a male nurse. A housekeeping staff should not be asked to interpret. When interpreters are used, they should be of the same country and religion, if possible, because of regional differences and hostilities.

 

DIF: Cognitive Level: Application REF: p. 31

 

OBJ: Nursing Process Step: Implementation MSC: Psychosocial Integrity

 

  1. A nurse is caring for a child with the religion of Christian Science. What interventions should the nurse include in the care plan for this child? Select all that apply.

 

Offer iced tea to the child who is experiencing fluid volume deficit.

 

Inform the Christian Science practitioner that the child has been admitted to the hospital.

 

Allow parents to sign a form opting out of routine immunizations.

 

 

 

Ask parents if the child has been baptized and if parents want a pastor to visit.

 

ANS: B, C

 

When a Christian Science believer is hospitalized, a parent or client may request that a Christian Science practitioner be notified. Christian Science believers seek exemption from immunizations but obey legal requirements. Coffee and tea are declined as a drink. Baptism is not a ceremony for the Christian Science religion.

 

DIF: Cognitive Level: Application REF: p. 29

 

OBJ: Nursing Process Step: Implementation MSC: Psychosocial Integrity

 

 

 

 

 

 

Chapter 20: The Child with a Genitourinary Alteration

 

Chapter 20: The Child with a Genitourinary Alteration Test Bank

 

MULTIPLE CHOICE

 

  1. Which statement made by a school-age girl indicates the need for further teaching about the prevention of urinary tract infections?

 

I always wear cotton underwear.

 

I really enjoy taking a bubble bath.

 

 

 

I go to the bathroom every 3 to 4 hours.

 

I drink four to six glasses of fluid every day.

 

 

ANS: B

 

Bubble baths should be avoided because they tend to cause urethral irritation, which leads to urinary tract infection. It is desirable to wear cotton rather than nylon underwear. Nylon tends to hold in moisture and promote bacterial growth, whereas cotton absorbs moisture. Children should be encouraged to urinate at least four times a day. An adequate fluid intake prevents the buildup of bacteria in the bladder.

 

DIF: Cognitive Level: Application REF: p. 463

 

OBJ: Nursing Process Step: Assessment MSC: Health Promotion and Maintenance

 

  1. The nurse assessing a child with acute poststreptococcal glomerulonephritis should be alert for which finding?

 

Increased urine output

 

Hypotension

 

Tea-colored urine

 

Weight gain

 

 

ANS: C

 

Acute poststreptococcal glomerulonephritis is characterized by hematuria, proteinuria, edema, and renal insufficiency. Tea-colored urine is an indication of hematuria. In acute poststreptococcal glomerulonephritis, the urine output may be decreased and the blood pressure increased. Edema may be noted around the eyelids and ankles in patients with acute poststreptococcal glomerulonephritis; however, weight gain is associated with nephrotic syndrome.

 

DIF: Cognitive Level: Application REF: p. 466

 

OBJ: Nursing Process Step: Assessment MSC: Physiological Integrity

 

The mother of a child who was recently diagnosed with acute glomerulonephritis asks the nurse why the physician keeps talking about casts in the urine. The nurses response is based

 

on the knowledge that the presence of casts in the urine indicates:

 

 

glomerular injury.

 

glomerular healing.

 

recent streptococcal infection.

 

excessive amounts of protein in the urine.

 

ANS: A

 

 

 

The presence of red blood cell casts in the urine indicates glomerular injury. Casts in the urine are abnormal findings and are indicative of glomerular injury, not glomerular healing. A urinalysis positive for casts does not confirm a recent streptococcal infection. Casts in the urine are unrelated to proteinuria.

 

DIF: Cognitive Level: Application REF: p. 466

 

OBJ: Nursing Process Step: Implementation MSC: Physiological Integrity

 

  1. What is a clinical finding that warrants further intervention for the child with acute poststreptococcal glomerulonephritis?

 

Weight loss to within 1 pound of the preillness weight

 

Urine output of 1 milliliter per kilogram per hour

 

A normal blood pressure

 

Inspiratory crackles

 

 

ANS: D

 

Children with excess fluid volume may have pulmonary edema. Inspiratory crackles indicate fluid in the lungs. Pulmonary edema can be a life-threatening complication. Weight loss to within 1 pound of the preillness weight is an indication that the child is responding to treatment. A urine output of 1 milliliter per kilogram per hour is an acceptable urine output and indicates that the child is responding to treatment. A normal blood pressure is also an indication that the child is responding to treatment.

 

DIF: Cognitive Level: Application REF: pp. 467-468

 

OBJ: Nursing Process Step: Planning MSC: Physiological Integrity

 

  1. Which diagnostic finding is assessed by the nurse when a child has primary nephrotic syndrome?

 

Hyperalbuminemia

 

Positive ASO titer

 

Leukocytosis

 

Proteinuria

 

 

ANS: D

 

Large amounts of protein are lost through the urine as a result of an increased permeability of the glomerular basement membrane. Hypoalbuminemia is present because of loss of albumin through the defective glomerulus and the livers inability to synthesize proteins to balance the loss. ASO titer is negative in a child with primary nephrotic syndrome. Leukocytosis is not a diagnostic finding in primary nephrotic syndrome.

 

 

DIF: Cognitive Level: Comprehension REF: p. 470

 

OBJ: Nursing Process Step: Assessment MSC: Physiological Integrity

 

  1. Which finding indicates that a child receiving prednisone for primary nephrotic syndrome is in remission?

 

Urine is negative for casts for 5 days.

 

Urine is 0 to trace for protein for 5 to 7 days.

 

Urine is negative for protein for 2 weeks.

 

Urine is 0 to trace for blood for 1 week.

 

 

ANS: B

 

The child receiving steroids for the treatment of primary nephrotic syndrome is considered in remission when the urine is 0 to trace for protein for 5 to 7 days. The absence of casts in the urine gives no indication about the childs response to treatment. The child with primary nephrotic syndrome is considered to be in remission when the urine is negative for protein for 5 to 7 consecutive days. The absence of proteinuria for 2 consecutive weeks indicates a continued remission. The presence or absence of hematuria is not used to determine remission in primary nephrotic syndrome.

 

DIF: Cognitive Level: Analysis REF: p. 471

 

OBJ: Nursing Process Step: Evaluation MSC: Physiological Integrity

 

  1. Which of the following statements made by a parent of a child with nephrotic syndrome indicates an understanding of a no-added-salt diet?

 

I only give my child sweet pickles.

 

My child just puts a little salt on his food.

 

I let my child have slightly salted potato chips.

 

I do not put any salt in foods when I am cooking.

 

 

ANS: D

 

A no-added-salt diet means that no salt should be added to foods, either when cooking or before eating. All types of pickles and potato chips are high in sodium and should not be served to the child on a no-added-salt diet. The child should not be allowed to use a salt shaker at meals when on a no-added-salt diet.

 

DIF: Cognitive Level: Analysis REF: p. 472

 

OBJ: Nursing Process Step: Evaluation MSC: Health Promotion and Maintenance

 

  1. Which is an appropriate intervention for a child with nephrotic syndrome who is edematous?

 

 

Teach the child to minimize body movements.

 

 

Change the childs position every 2 hours.

 

Avoid the use of skin lotions.

 

Bathe every other day.

 

 

ANS: B

 

Frequent position changes decrease pressure on body parts and help relieve edema in dependent areas. The child with edema is at risk for impaired skin integrity. It is important for the child to change position frequently to prevent skin breakdown. Applying lotion to the skin helps to increase circulation. Bathing daily removes irritating body secretions from the skin. DIF: Cognitive Level: Application REF: p. 473

 

OBJ: Nursing Process Step: Implementation MSC: Physiological Integrity

 

  1. A child with secondary enuresis who complains of dysuria or urgency should be evaluated for which condition?

 

Hypocalciuria

 

Nephrotic syndrome

 

Glomerulonephritis

 

Urinary tract infection

 

 

ANS: D

 

Complaints of dysuria or urgency from a child with secondary enuresis suggest the possibility of a urinary tract infection. An excessive loss of calcium in the urine (hypercalciuria) can be associated with complaints of painful urination, urgency, frequency, and wetting. Nephrotic syndrome is not usually associated with complaints of dysuria or urgency. Glomerulonephritis is not a likely cause of dysuria or urgency.

 

DIF: Cognitive Level: Comprehension REF: p. 458

 

OBJ: Nursing Process Step: Evaluation MSC: Physiological Integrity

 

  1. What should the nurse include in a teaching plan for the parents of a child with vesicoureteral reflux?

 

Screening for urinary tract infection (UTI) if febrile

 

Suggestions for how to maintain fluid restrictions

 

The use of bubble baths as an incentive to increase bath time

 

The need for the child to hold urine for 6 to 8 hours

 

 

ANS: A

 

A child with vesicoureteral reflux is screened for a UTI if febrile. Fluids are not restricted when a child has vesicoureteral reflux. In fact, fluid intake should be increased as a measure to prevent

 

 

urinary tract infections. Bubble baths should be avoided to prevent urethral irritation and possible

 

urinary tract infection. To prevent urinary tract infections, the child should be taught to void

 

frequently and never resist the urge to urinate.

 

DIF: Cognitive Level: Application REF: p. 462

 

OBJ: Nursing Process Step: Implementation MSC: Physiological Integrity

 

  1. Which intervention is appropriate when examining a male infant for cryptorchidism?

 

 

Cooling the examiners hands

 

Taking a rectal temperature

 

Placing the infant on the examination table

 

Warming the room

 

 

ANS: D

 

For the infants comfort, the infant should be examined in a warm room with the examiners hands warmed. Testes can retract into the inguinal canal if the infant is upset or cold. Examining the infant with cold hands is uncomfortable for the infant and is likely to cause the infants testes to retract into the inguinal canal. It may also cause the infant to be uncooperative during the examination. A rectal temperature yields no information about cryptorchidism. When possible, the infant should be examined in the caregivers lap to elicit cooperation and avoid upsetting the infant.

 

DIF: Cognitive Level: Application REF: p. 465

 

OBJ: Nursing Process Step: Implementation MSC: Physiological Integrity

 

Parents ask the nurse, When should our childs hypospadias be corrected? The nurse responds based upon the knowledge that correction of hypospadias should be accomplished by

 

the time the child is:

 

 

1 month of age.

 

6 to 8 months of age.

 

school age.

 

sexually mature.

 

 

ANS: B

 

The correction of hypospadias should ideally be accomplished by the time the child is 6 to 8 months of age and before toilet training. Surgery to correct hypospadias is not performed when the infant is less than 6 months of age. It is preferable for hypospadias to be surgically corrected before the child enters school so that the child has normal toileting behaviors in the presence of his peers. Corrective surgery for hypospadias is done long before sexual maturity.

 

 

DIF: Cognitive Level: Application REF: p. 465

 

OBJ: Nursing Process Step: Planning MSC: Physiological Integrity

 

  1. A nurse is teaching a class on acute renal failure. The nurse relates that acute renal failure as a result of hemolytic-uremic syndrome is classified as:

 

prerenal.

 

intrarenal.

 

postrenal.

 

chronic.

 

 

ANS: B

 

Intrarenal acute renal failure is the result of damage to kidney tissue. Possible causes of intrarenal acute renal failure are hemolytic uremic syndrome, glomerulonephritis, and pyelonephritis. Prerenal acute renal failure is the result of decreased perfusion to the kidney. Possible causes include dehydration, septic and hemorrhagic shock, and hypotension. Postrenal acute renal failure results from obstruction of urine outflow. Conditions causing postrenal failure include ureteropelvic obstruction, ureterovesical obstruction, or neurogenic bladder. Renal failure caused by hemolytic-uremic syndrome is of the acute nature. Chronic renal failure is an irreversible loss of kidney function, which occurs over months or years. DIF: Cognitive Level: Comprehension REF: p. 474

 

OBJ: Nursing Process Step: Assessment MSC: Physiological Integrity

 

  1. Which dietary modification is appropriate for a child with chronic renal failure?

 

 

Decreased salt

 

Decreased fat

 

Increased potassium

 

Increased phosphorus

 

 

ANS: A

 

Salt is restricted to prevent fluid overload and hypertension. A low-fat diet is not relevant to chronic renal failure. Potassium intake may be restricted because of the kidneys inability to remove it. Phosphorus is restricted to help prevent bone disease. DIF: Cognitive Level: Comprehension REF: p. 477

 

OBJ: Nursing Process Step: Planning MSC: Health Promotion and Maintenance

 

  1. Which condition is characterized by a history of bloody diarrhea, fever, abdominal pain, and low hemoglobin and platelet counts?

 

Acute viral gastroenteritis

 

 

Acute glomerulonephritis

 

Hemolytic-uremic syndrome

 

Acute nephrotic syndrome

 

 

ANS: C

 

Hemolytic-uremic syndrome is an acute disorder characterized by anemia, thrombocytopenia,

 

and acute renal failure. Most affected children have a history of gastrointestinal symptoms,

 

including bloody diarrhea. Anemia and thrombocytopenia are not associated with acute

 

gastroenteritis. The symptoms described are not suggestive of acute glomerulonephritis or

 

nephrotic syndrome.

 

DIF: Cognitive Level: Comprehension REF: p. 474

 

OBJ: Nursing Process Step: Assessment MSC: Physiological Integrity

 

  1. Which is a true statement describing the differences in the pediatric genitourinary system compared with the adult genitourinary system?

 

The young infants kidneys can more effectively concentrate urine than can an adults kidneys.

 

After 6 years of age, kidney function is nearly like that of an adult.

 

Unlike adults, most children do not regain normal kidney function after acute renal failure.

 

Young children have shorter urethras, which can predispose them to urinary tract infections.

 

 

ANS: D

 

Young children have shorter urethras, which can predispose them to urinary tract infections. The young infants kidneys cannot concentrate urine as efficiently as those of older children and adults because the loop of Henle is not yet long enough to reach the inner medulla, where concentration and reabsorption occur. By 6 to 12 months of age, kidney function is nearly like that of an adult. Unlike adults, most children with acute renal failure regain normal function. DIF: Cognitive Level: Comprehension REF: p. 455

 

OBJ: Nursing Process Step: Assessment MSC: Health Promotion and Maintenance MULTIPLE RESPONSE

 

  1. A nurse is planning care for a child admitted with nephrotic syndrome. Which interventions should be included in the plan of care? Select all that apply.

 

Administration of antihypertensive medications

 

Daily weights

 

Salt-restricted diet

 

Frequent position changes

 

Teach parents to expect tea-colored urine

 

 

 

ANS: B, C, D

 

A child with nephrotic syndrome will need to be monitored closely for fluid excess so daily weights are important. The diet is salt restricted to prevent further retention of fluid. Because of the fluid excess, frequent position changes are required to prevent skin breakdown. Nephrotic syndrome does not require antihypertensive medications. These are administered for acute glomerulonephritis. Tea-colored urine is expected with acute glomerulonephritis, but not nephrotic syndrome. The urine in nephrotic syndrome is frothy indicating protein is being lost in the urine.

 

DIF: Cognitive Level: Application REF: p. 472

 

OBJ: Nursing Process Step: Planning MSC: Physiological Integrity

 

  1. A nurse is assessing an infant for urinary tract infection (UTI). Which assessment findings should the nurse expect? Select all that apply.

 

Change in urine odor or color

 

Enuresis

 

Fever or hypothermia

 

Voiding urgency

 

Poor weight gain

 

 

ANS: A, C, E

 

The signs of a UTI in an infant include fever or hypothermia, irritability, dysuria as evidenced by crying when voiding, change in urine odor or color, poor weight gain and feeding difficulties. Enuresis and voiding urgency would be assessed in an older child. DIF: Cognitive Level: Analysis REF: p. 462

 

OBJ: Nursing Process Step: Assessment MSC: Physiological Integrity

 

 

Chapter 31: The Child with a Sensory Alteration

 

Chapter 31: The Child with a Sensory Alteration Test Bank

 

MULTIPLE CHOICE

 

A child tells the school nurse that he cant see things at a distance very clearly but he can read up close fine. The nurse knows that the refractive disorder causing the ability to see distant

 

objects less clearly than those close up is termed:

 

 

hyphema.

 

astigmatism.

 

amblyopia.

 

myopia.

 

 

ANS: D

 

Myopic patients have the ability to see near objects more clearly than those at a distance; it is caused by the image focusing beyond the retina. Hyphema includes hemorrhage in the anterior chamber and is not a refractive disorder. Astigmatism is caused by an abnormal curvature of the cornea or lens. Amblyopia is a problem of reduced visual acuity not correctable by refraction. DIF: Cognitive Level: Comprehension REF: p. 819

 

OBJ: Nursing Process Step: Evaluation MSC: Health Promotion and Maintenance

 

The parents of a child needing glasses ask the nurse when can we consider contact lenses for our child? The nurse should respond to this question relating that contact lenses should be

 

prescribed for a child who is:

 

 

at least 12 years of age.

 

able to read all the written information and instructions.

 

able to independently care for the lenses in a responsible manner.

 

confident that she really wants contact lenses.

 

 

ANS: C

 

The child must be able to care for the lenses independently. Serious eye damage can occur with irresponsible use of contact lenses; confidence and wanting do not equal responsibility.

 

 

Chronological age is not the major determinant. A responsible 10-year-old child might be permitted to wear contact lenses, but the ability to read does not indicate understanding of the instructions.

 

DIF: Cognitive Level: Application REF: p. 820

 

OBJ: Nursing Process Step: Implementation

 

MSC: Health Promotion and Maintenance

 

  1. Which statement best describes how a cataract affects a childs vision?

 

 

It increases intraocular pressure.

 

It alters the ability to distinguish between colors.

 

It causes double vision.

 

It prevents a clear image from forming on the retina.

 

 

ANS: D

 

A cataract is an opacity of the lens or loss of transparency of the lens and usually does not cause double vision. Coughing, straining, or vomiting can increase intraocular pressure postoperatively. Nystagmus and strabismus are clinical signs of a cataract. Color deficiency is not a sign.

 

DIF: Cognitive Level: Knowledge REF: p. 822

 

OBJ: Nursing Process Step: Assessment MSC: Physiological Integrity

 

  1. Which statement about conjunctivitis made by a parent would indicate that further teaching is needed?

 

Ill have separate towels and washcloths for each family member.

 

Ill notify my doctor if the eye gets redder or the drainage increases.

 

When the eye drainage improves, well stop giving the antibiotic ointment.

 

After taking the antibiotic for 24 hours, my child can return to school.

 

 

ANS: C

 

The antibiotic should be continued for the full prescription and the child should be kept home from school or day care until he receives the antibiotic for 24 hours. Maintaining separate towels and washcloths will prevent the other family members from acquiring the infection. If the infection proliferates, the physician should be contacted. DIF: Cognitive Level: Application REF: p. 824

 

OBJ: Nursing Process Step: Evaluation MSC: Physiological Integrity

 

  1. Which teaching guideline would help prevent eye injuries during sports and play activities?

 

 

Restrict helmet use to those who wear eye glasses or contact lenses.

 

 

Discourage the use of goggles with helmets.

 

Wear eye protection when participating in high-risk sports such as paintball.

 

Wear a face mask when playing any sport or playing roughly.

 

 

ANS: C

 

High-risk sports such as paintball can cause penetrating eye injuries. Eye protection should be

 

worn. All children who play games should be protected by the appropriate headgear with goggles

 

and helmets being used concurrently. A face mask does not prevent damage to the childs head.

 

DIF: Cognitive Level: Comprehension REF: p. 826

 

OBJ: Nursing Process Step: Implementation

 

MSC: Health Promotion and Maintenance

 

A nurse is admitting a child with a chemical burn to the eye. The nurse questions the EMS personnel about initial care at the time of the injury. The nurse understands that initial care of the

 

child with a chemical burn to the eye(s) is focused on:

 

 

irrigation of the affected eye(s).

 

application of topical steroids.

 

administration of an analgesic.

 

administration of medication to constrict the pupils.

 

 

ANS: A

 

Chemical eye burns are an ocular emergency and are best managed by immediate irrigation of the eye(s) with water or normal saline solution. Topical steroids usually are applied after irrigation. Caring for a frightened child is very difficult. Pain medication may help the child cope with the situation, but the initial care is irrigation. Further treatment may include the use of medications to dilate the pupils to decrease the risk of adhesions. DIF: Cognitive Level: Comprehension REF: p. 826

 

OBJ: Nursing Process Step: Assessment MSC: Physiological Integrity 7. Which type of hearing loss in a child is usually irreversible?

 

Conductive

 

Sensorineural

 

Central

 

Nonconductive

 

 

ANS: B

 

When hearing loss is caused by malformations, auditory nerve damage, or infection the loss is usually permanent. Damage caused by inflammation or obstruction usually causes a temporary

 

 

and reversible hearing loss. A central type of hearing loss usually causes difficulties in differentiating sounds and problems with auditory memory and it is reversible. Nonconductive hearing loss is commonly reversed with surgery or medication. DIF: Cognitive Level: Comprehension REF: p. 827

 

OBJ: Nursing Process Step: Planning MSC: Health Promotion and Maintenance

 

  1. On the second postoperative day following an eye surgery, the child has puffy eyes, increased drainage, and tearing. Which is the most applicable nursing diagnosis?

 

Risk for infection related to the surgical procedure

 

Risk for injury related to increased intraocular pressure

 

Disturbed sensory perception (visual) related to the surgical procedure

 

Acute pain related to recent surgical intervention

 

 

ANS: A

 

Any surgical procedure leaves the patient vulnerable to infection. There is no datum in the scenario to validate increased intraocular pressure or to support a diagnosis for disturbed sensory perception (visual) related to a surgical procedure. Usually eye surgeries are relatively painless. DIF: Cognitive Level: Application REF: p. 823

 

OBJ: Nursing Process Step: Nursing Diagnosis MSC: Physiological Integrity

 

  1. Parents of a 4-year-old child are concerned because he continues to stutter. Which nursing intervention is correct?

 

Remind the parents that stuttering is normal in children younger than 10 years.

 

Ask the parents to have a speech evaluation performed if the stuttering continues beyond the age of 5

 

Reinforce the fact that this common speech defect requires no treatment.

 

Tell the parents that speech problems are most treatable during the childs teen years.

 

 

ANS: B

 

If stuttering persists after 5 years of age, the child should be seen by the physician and referred to a speech therapist. Stuttering is not normal after the age of 5 years. Early diagnosis, intervention, and treatment are critical in assisting the child to develop as normally as possible and to correct the speech disorder.

 

DIF: Cognitive Level: Application REF: p. 829

 

OBJ: Nursing Process Step: Implementation

 

MSC: Health Promotion and Maintenance

 

 

A 13-year-old adolescent is diagnosed with a sensory alteration and is scheduled for diagnostic tests. She asks the nurse to tell her the truth about the tests. Which response is the

best?

 

 

Dont worry about anything. Were here to take good care of you.

 

Ask your parents. They have talked with the physicians.

 

Most of the tests are painless and noninvasive.

 

Trust the doctors. They know what is best for you.

 

 

ANS: C

 

The nurse should be knowledgeable and honest in answering questions about procedures. The nurse should not provide false reassurance as it blocks communication. A 13-year-old adolescent is old enough to comprehend explanations and is entitled to receive the pertinent information regarding her health. Patients, especially teenagers, do not appreciate healthcare providers who do not treat them with honesty and respect.

 

DIF: Cognitive Level: Application REF: pp. 827-828

 

OBJ: Nursing Process Step: Implementation MSC: Psychosocial Integrity

 

  1. Teaching parents about the use and application of an eye patch to treat strabismus should include which information?

 

Check the patched eye four times a day by removing the patch and replacing it after inspection.

 

Apply the patch directly to the face.

 

Sometimes patching alone will straighten the eye.

 

Negotiate with the child for the number of hours per day that the patch is to be worn.

 

 

ANS: B

 

The patch should be securely applied to the face. Parents often apply the eye patch to the childs eyeglasses. Once the patch is in place, it should remain there for the prescribed number of hours. Patching alone will not straighten the eye. The amount of time the child wears the eye patch is not negotiable. Parents should learn strategies for dealing with resistant behaviors. DIF: Cognitive Level: Comprehension REF: p. 820

 

OBJ: Nursing Process Step: Planning MSC: Health Promotion and Maintenance

 

  1. The correct position for the postoperative child who has had a cataract removed from the right eye is the _____ position.

 

supine

 

prone

 

knee-chest

 

 

 

right lateral Sims

 

ANS: A

 

To prevent edema and pressure on the operative site, the nurse should elevate the head of the bed slightly and avoid placing the child in a dependent position. The prone position is a dependent position, which is contraindicated after cataract surgery. The knee-chest position is contraindicated after cataract surgery. The right lateral Sims position would increase pressure on the operative site.

 

DIF: Cognitive Level: Application REF: p. 822

 

OBJ: Nursing Process Step: Implementation MSC: Physiological Integrity

 

  1. Which manifestation in a 5-month-old child could indicate visual problems?

 

 

Lack of binocularity

 

Visual acuity of 20/50

 

Strabismus

 

Hyperopia

 

 

ANS: C

 

Strabismus is normal in the young infant but should not be present after 3 months of age. Binocularity, the ability to fixate on one visual field with both eyes, is not present at birth but is established by 6 months of age. Visual acuity by 4 months of age is between 20/50 and 20/80. Hyperopia, or farsightedness, is normal until about 7 years of age. DIF: Cognitive Level: Comprehension REF: p. 818

 

OBJ: Nursing Process Step: Assessment MSC: Health Promotion and Maintenance

 

  1. The nurse should teach parents that the results of untreated amblyopia in the child may result in:

 

impaired depth perception.

 

strabismus.

 

color deficiency.

 

ptosis.

 

 

ANS: A

 

Untreated amblyopia causes the child to lose binocular vision, which may impair depth perception. Amblyopia, or decreased vision in the deviated eye, results from strabismus. Color deficiency and ptosis, or dropping of the eyelid, are not the result of untreated amblyopia. DIF: Cognitive Level: Application REF: p. 820 OBJ: Nursing Process Step: Implementation

 

 

MSC: Health Promotion and Maintenance

 

  1. The teaching plan for the parents of a 3-year-old child with amblyopia should include which instructions?

 

Apply a patch to the childs eyeglass lenses.

 

Apply a patch only during waking hours.

 

Apply a patch over the bad eye to strengthen it.

 

Cover the good eye completely with a patch.

 

 

ANS: D

 

The good eye is patched to force the child to use the bad eye, thus strengthening the muscles. The patch should always be applied directly to the childs face, not to eyeglasses, and should be left in place even when the child is sleeping. Covering the bad eye will not contribute to strengthening it. The good eye should be patched. DIF: Cognitive Level: Application REF: p. 820

 

OBJ: Nursing Process Step: Planning MSC: Physiological Integrity

 

  1. The teaching plan for a 7-year-old boy with color deficiency should include which instruction?

 

Buy only one color of clothing to ensure the childs ability to match items himself.

 

Patching the weaker eye will improve his color vision.

 

Teach him an alternate way to distinguish between the colors of traffic signals.

 

Botulism toxin drops will need to be administered every 2 months to improve color vision.

 

 

ANS: C

 

The child who cannot distinguish colors of warning signals must be taught an alternative way to identify these signals. Clothes may be labeled or organized so the child can identify them. They do not have to be purchased in only one color. There is no cure, treatment, or correction for color blindness. Because the eye is not weak, patching will not correct the color deficiency. The child can be taught adaptive measures to compensate for the condition. DIF: Cognitive Level: Application REF: p. 818

 

OBJ: Nursing Process Step: Planning MSC: Health Promotion and Maintenance

 

  1. A 2-year-old girl has excessive tearing and corneal haziness. The nurse knows that these symptoms may indicate:

 

viral conjunctivitis.

 

paralytic strabismus.

 

congenital cataract.

 

 

 

infantile glaucoma.

 

ANS: D

 

Excessive tearing and corneal haziness are indicative of glaucoma. Because the child is younger than 3 years of age, it would be classified as infantile. Discharge is noted with conjunctivitis. Corneal haziness is not a symptom of conjunctivitis. Paralytic strabismus is caused by weakness or paralysis of one or more of the extraocular muscles. Neither tearing nor corneal haziness is a symptom of paralytic strabismus. Congenital cataract will cause an opacity, but not excessive tearing.

 

DIF: Cognitive Level: Knowledge REF: p. 821

 

OBJ: Nursing Process Step: Assessment MSC: Physiological Integrity

 

  1. Which should be the most significant nursing intervention in caring for a child who has just returned from eye surgery to prevent increasing intraocular pressure?

 

Monitor for hypertension, which is a symptom of increased intraocular pressure.

 

Prevent coughing and vomiting.

 

Lower the head of the bed slightly and place the eye in a dependent position.

 

Avoid use of steroids after the surgery.

 

 

ANS: B

 

Preventing coughing, straining, vomiting, and touching the operative site are all measures

 

directed toward avoiding increased intraocular pressure. Hy

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