Wong Nursing Care of Infants and Children 9th Edition by Marilyn J. Hockenberry, David Wilson Test Bank

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Wong Nursing Care of Infants and Children 9th Edition by Marilyn J. Hockenberry, David Wilson Test Bank

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WITH ANSWERS

Wongs Nursing Care of Infants and Children 9th Edition by Marilyn J. Hockenberry, David Wilson Test Bank

Hockenberry: Wongs Nursing Care of Infants and Children, 9th Edition

 

Chapter 02: Social, Cultural, and Religious Influences on Child Health Promotion

 

Test Bank

 

MULTIPLE CHOICE

 

  1. Children are taught the values of their culture through observation and feedback, relative to their own behavior. In teaching a class on cultural competence, the nurse should be aware that which of the following factors may be culturally determined?
a. Ethnicity
b. Racial variation
c. Status
d. Geographic boundaries

 

 

ANS:  C

Status is culturally determined and varies according to each culture. Some cultures ascribe higher status to age or socioeconomic position. Social roles also are influenced by the culture. Ethnicity is an affiliation of a set of persons who share a unique cultural, social, and linguistic heritage. It is one component of culture. Race and culture are two distinct attributes. Racial grouping describes transmissible traits, whereas culture is determined by the pattern of assumptions, beliefs, and practices that unconsciously frames or guides the outlook and decisions of a group of people. Cultural development may be limited by geographic boundaries, but the boundaries are not culturally determined.

 

DIF:    Cognitive Level: Analysis               REF:   p. 21

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Psychosocial Integrity

 

  1. When minority groups immigrate to another country, a certain degree of cultural and ethnic blending occurs through the involuntary process of:
a. acculturation.
b. ethnocentrism.
c. cultural shock.
d. cultural sensitivity.

 

 

ANS:  A

Acculturation is the gradual changes that are produced in a culture by the influence of another culture that cause one or both cultures to become more similar. The minority culture is forced to learn the majority culture to survive. Ethnocentrism is the belief that ones way of living and behaving is the best way. This includes the emotional attitude that the values, beliefs, and perceptions of ones ethnic group are superior to those of others. Cultural shock is the helpless feeling and state of disorientation felt by an outsider attempting to adapt to a different culture group. Ethnocentrism and cultural shock would limit the amount of blending that would occur. Cultural sensitivity, a component of culturally competent care, is an awareness of cultural similarities and differences.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 23

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Psychosocial Integrity

 

  1. Which of the following terms best describes the emotional attitude that ones own ethnic group is superior to others?
a. Culture
b. Ethnicity
c. Superiority
d. Ethnocentrism

 

 

ANS:  D

Ethnocentrism is the belief that ones way of living and behaving is the best way. This includes the emotional attitude that the values, beliefs, and perceptions of ones ethnic group are superior to those of others. Culture is a pattern of assumptions, beliefs, and practices that unconsciously frames or guides the outlook and decisions of a group of people. A culture is composed of individuals who share a set of values, beliefs, and practices that serve as a frame of reference for individual perception and judgments. Ethnicity is an affiliation of a set of persons who share a unique cultural, social, and linguistic heritage. Superiority is the state or quality of being superior; it does not apply to ethnicity.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 24

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Psychosocial Integrity

 

  1. After the family, which of the following is likely to have the greatest influence on providing continuity between generations?
a. Race
b. Schools
c. Social class
d. Government

 

 

ANS:  B

The schools convey a tremendous amount of culture from the older members to the younger members of society. They prepare children to carry out the traditional social roles that will be expected of them as adults. Race is defined as a division of mankind possessing traits that are transmissible by descent and are sufficient to characterize it as a distinct human type; although race may have an influence on childrearing practices, its role is not as significant as that of schools. Social class refers to the familys economic and educational levels. The social class of a family may change between generations. The government establishes parameters for children, including amount of schooling, but this is usually at a local level. The school culture has the significant influence on continuity.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 25

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Psychosocial Integrity

 

  1. The nurse observes that families from certain minority cultural groups often miss or are late for scheduled clinic appointments. The best explanation for this is that certain cultural groups often differ from the dominant culture because they:
a. lack education.
b. avoid health care.
c. are more forgetful.
d. view time differently.

 

 

ANS:  D

Each cultural group has different conceptions of time and waiting. The dominant culture in the United States has a fairly rigid view of time. Persons from other cultures may be late or miss activities because other issues take precedence over the appointment. Education is not the issue, nor is avoidance of health care. The family usually believes that the appointment can be made for a later time. The family does not forget the time, but other issues take priority.

 

DIF:    Cognitive Level: Application          REF:   p. 30

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Psychosocial Integrity

 

  1. The Asian parent of a child being seen in the clinic avoids eye contact with the nurse. The best explanation for this, considering cultural differences, is that the parent:
a. feels inferior to nurse.
b. is showing respect for nurse.
c. is embarrassed to seek health care.
d. feels responsible for her childs illness.

 

 

ANS:  B

In some ethnic groups, eye contact is avoided. In the Vietnamese culture an individual may not look directly into the nurses eyes as a sign of respect. The nurse providing culturally competent care would recognize that the other answers listed are not why the parent avoids eye contact with the nurse.

 

DIF:    Cognitive Level: Analysis               REF:   p. 32

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Psychosocial Integrity

 

  1. The nurse is planning care for a patient with a different ethnic background. Which of the following would be an appropriate goal?
a. Adapt, as necessary, ethnic practices to health needs.
b. Attempt, in a nonjudgmental way, to change ethnic beliefs.
c. Encourage continuation of ethnic practices in the hospital setting.
d. Strive to keep ethnic background from influencing health needs.

 

 

ANS:  A

Whenever possible, nurses should facilitate the integration of ethnic practices into health care provision. The ethnic background is part of the individual; it would be difficult to eliminate the influence of ethnic background. The ethnic practices need to be evaluated within the context of the health care setting to determine whether they are conflicting.

 

DIF:    Cognitive Level: Application          REF:   p. 36

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Psychosocial Integrity

 

  1. The nurse discovers welts on the back of a Vietnamese child during a home health visit. The childs mother says she has rubbed the edge of a coin on her childs oiled skin. The nurse should recognize this is which of the following?
a. Child abuse
b. Cultural practice to rid the body of disease
c. Cultural practice to treat enuresis or temper tantrums
d. Child discipline measure common in the Vietnamese culture

 

 

ANS:  B

This is descriptive of coining. The welts are created by repeatedly rubbing a coin on the childs oiled skin. The mother is attempting to rid the childs body of disease. Coining is a cultural healing practice. Coining is not specific for enuresis or temper tantrums. This is not child abuse or discipline.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 35

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Psychosocial Integrity

 

  1. A Hispanic toddler has pneumonia. The nurse notices that the parent consistently feeds the child only the broth that comes on the clear liquid tray. Food items, such as Jell-O, Popsicles, and juices, are left. Which of the following would best explain this?
a. Parent is trying to feed child only what child likes most.
b. Hispanics believe the evil eye enters when a person gets cold.
c. Parent is trying to restore normal balance through appropriate hot remedies.
d. Hispanics believe an innate energy called chi is strengthened by eating soup.

 

 

ANS:  C

In several cultures, including Filipino, Chinese, Arabic, and Hispanic, hot and cold describe certain properties completely unrelated to temperature. Respiratory conditions such as pneumonia are cold conditions and are treated with hot foods. The child may like broth but is unlikely to always prefer it to Jell-O, Popsicles, and juice. The evil eye applies to a state of imbalance of health, not curative actions. Chinese individuals, not Hispanic individuals, believe in chi as an innate energy.

 

DIF:    Cognitive Level: Application          REF:   p. 34

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Psychosocial Integrity

 

  1. The nurse recognizes that some genetic diseases are more prevalent in certain groups and geographic areas. Which of the following disorders is more likely to be identified in individuals of Mediterranean descent?
a. Phenylketonuria
b. Cystic fibrosis
c. G6PD deficiency
d. Sickle cell anemia

 

 

ANS:  C

Glucose-6 phosphate dehydrogenase (G6PD) deficiency is more commonly found in individuals of Mediterranean descent. Phenylketonuria is more prevalent in individuals of northern European origin. Cystic fibrosis is more prevalent in individuals from England and Scotland. Sickle cell anemia is more prevalent in individuals of African descent.

 

DIF:    Cognitive Level: Application          REF:   p. 40

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Psychosocial Integrity

 

  1. Which one of the following communicable diseases is more prevalent in certain ethnic groups, such as Vietnamese immigrants?
a. Tuberculosis
b. Rubeola
c. Varicella
d. Pertussis

 

 

ANS:  A

Tuberculosis is a more prevalent communicable disease among certain ethnic groups such Vietnamese immigrants, Native Americans of the Southwest, and Mexican-Americans. Rubeola is a common communicable disease with a geographic constraint. Varicella and pertussis do not have ethnic prevalence.

 

DIF:    Cognitive Level: Application          REF:   p. 39

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Psychosocial Integrity

 

MULTIPLE RESPONSE

 

  1. The nurse is presenting a staff development program about cultural competency in the health care setting. Which of the following components should the nurse include in the program? Select all that apply.
a. Cultural awareness
b. Cultural knowledge
c. Cultural skills
d. Cultural research
e. Cultural desire
f. Cultural bias

 

 

ANS:  A, B, C, E

Five components that should be discussed in a program about cultural competency include awareness (the nurse appreciates and is sensitive to the familys cultural values), knowledge (formal and informal education about different cultures, beliefs, and perceptions about health and wellness), skills (the ability to include cultural data in the nursing process), and desire (the genuine motivation to work effectively with minority patients). Cultural research and cultural bias are not components of cultural competency.

 

DIF:    Cognitive Level: Analysis               REF:   p. 36

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Psychosocial Integrity

 

 

Hockenberry: Wongs Nursing Care of Infants and Children, 9th Edition

 

Chapter 14: Health Promotion of the Toddler and Family

 

Test Bank

 

MULTIPLE CHOICE

 

  1. Which one of the following factors is most important in predisposing toddlers to frequent infections?
a. Respirations are abdominal.
b. Pulse and respiratory rates in toddlers are slower than those in infancy.
c. Defense mechanisms are less efficient than those during infancy.
d. Toddlers have a short, straight internal ear canal and large lymph tissue.

 

 

ANS:  D

Toddlers continue to have the short, straight internal ear canal of infants. The lymphoid tissue of the tonsils and adenoids continues to be relatively large. These two anatomic conditions combine to predispose the toddler to frequent infections. The abdominal respirations and lowered pulse and respiratory rate of toddlers do not affect their susceptibility to infection. The defense mechanisms are more efficient compared with those of infancy.

 

DIF:    Cognitive Level: Analysis               REF:   p. 555

TOP:   Nursing Process: Assessment

MSC:  Client Needs: Physiological Integrity: Reduction of Risk Potential

 

  1. The psychosocial developmental tasks of toddlerhood include which of the following?
a. Development of a conscience
b. Recognition of sex differences
c. Ability to get along with age-mates
d. Ability to delay gratification

 

 

ANS:  D

If the need for basic trust has been satisfied, then toddlers can give up dependence for control, independence, and autonomy. One of the tasks that the toddler is concerned with is the ability to delay gratification. Development of a conscience and recognition of sex differences occur during the preschool years. The ability to get along with age-mates develops during the preschool and school-age years.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 556

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Psychosocial Integrity

 

  1. The developmental task with which the child of 15 to 30 months is likely to be struggling is a sense of what?
a. Trust
b. Initiative
c. Intimacy
d. Autonomy

 

 

ANS:  D

Autonomy versus shame and doubt is the developmental task of toddlers. Trust versus mistrust is the developmental stage of infancy. Initiative versus guilt is the developmental stage of early childhood. Intimacy and solidarity versus isolation is the developmental stage of early adulthood.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 583

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Health Promotion and Maintenance

 

  1. A parent of an 18-month-old boy tells the nurse that he says no to everything and has rapid mood swings. If he is scolded, he shows anger and then immediately wants to be held. The nurses best interpretation of this behavior is which of the following?
a. This is normal behavior for his age.
b. This is unusual behavior for his age.
c. He is not effectively coping with stress.
d. He is showing he needs more attention.

 

 

ANS:  A

Toddlers use distinct behaviors in the quest for autonomy. They express their will with continued negativity and use of the word no. Children at this age also have rapid mood swings. The nurse should reassure the parents that their child is engaged in expected behavior for an 18-month-old.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 556

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Health Promotion and Maintenance

 

  1. A 17-month-old child would be expected to be in what stage, according to Piaget?
a. Preoperations
b. Concrete operations
c. Tertiary circular reaction
d. Secondary circular reaction

 

 

ANS:  C

The 17-month-old is in the fifth stage of the sensorimotor phase, tertiary circular reactions. The child uses active experimentation to achieve previously unattainable goals. Preoperations is the stage of cognitive development usually present in older toddlers and preschoolers. Concrete operations is the cognitive stage associated with the school-age child. Secondary circular reaction stage lasts from about ages 4 to 8 months.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 556

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Health Promotion and Maintenance

 

  1. Although a 14-month-old girl received a shock from an electrical outlet recently, her parent finds her about to place a paper clip in another outlet. Which of the following is the best interpretation of this behavior?
a. Her cognitive development is delayed.
b. This is typical behavior because toddlers are not very developed.
c. This is typical behavior because of inability to transfer knowledge to new situations.
d. This is not typical behavior because toddlers should know better than to repeat an act that caused pain.

 

 

ANS:  C

During the tertiary circular reactions stage, children have only a rudimentary sense of the classification of objects. The appearance of an object denotes its function for these children. The slot of an outlet is for putting things into. This is typical behavior for a toddler, who is only somewhat aware of a causal relation between events. Her cognitive development is appropriate for her age.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 557

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Health Promotion and Maintenance

 

  1. A toddler, age 16 months, falls down a few stairs. He gets up and scolds the stairs as if they caused him to fall. This is an example of which of the following?
a. Animism
b. Ritualism
c. Irreversibility
d. Delayed cognitive development

 

 

ANS:  A

Animism is the attribution of lifelike qualities to inanimate objects. By scolding the stairs, the toddler is attributing human characteristics to them. Ritualism is the need to maintain the sameness and reliability. It provides a sense of comfort to the toddler. Irreversibility is the inability to reverse or undo actions initiated physically. He is acting in an age-appropriate manner.

 

DIF:    Cognitive Level: Analysis               REF:   p. 559

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Health Promotion and Maintenance

 

  1. Which of the following is a characteristic of a toddlers language development at age 18 months?
a. Vocabulary of 25 words
b. Use of holophrases
c. Increasing level of comprehension
d. Approximately one third of speech understandable

 

 

ANS:  C

During the second year of life the comprehension and understanding of speech increase to a level far greater than the childs vocabulary. This is also true for bilingual children, who are able to achieve this linguistic milestone in both languages. The 18-month-old has a vocabulary of approximately 10 words. At this age the child does not use the one-word sentences that are characteristic of 1-year-olds. The child has a very limited vocabulary of single words that are comprehensible.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 561

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Health Promotion and Maintenance

 

  1. Which of the following characteristics best describes the gross motor skills of a 24-month-old child?
a. Skips
b. Broad jumps
c. Rides tricycle
d. Walks up and down stairs

 

 

ANS:  D

The 24-month-old child can go up and down stairs alone with two feet on each step. Skipping and broad jumping are skills acquired at age 3. Tricycle riding is achieved at age 4.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 565

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Health Promotion and Maintenance

 

  1. Which of the following developmental characteristics does not occur until a child reaches age 2 1/2 years?
a. Birth weight has doubled.
b. Anterior fontanel is open.
c. Primary dentition is complete.
d. Binocularity may be established.

 

 

ANS:  C

Usually by age 30 months the primary dentition of 20 teeth is complete. Birth weight doubles at approximately ages 5 to 6 months. The anterior fontanel closes at ages 12 to 18 months. Binocularity is established by age 15 months.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 565

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Health Promotion and Maintenance

 

  1. Which of the following statements is correct about toilet training?
a. Bladder training is usually accomplished before bowel training.
b. Wanting to please the parent helps motivate the child to use the toilet.
c. Watching older siblings use the toilet confuses the child.
d. Children must be forced to sit on the toilet when first learning.

 

 

ANS:  B

Voluntary control of the anal and urethral sphincters is achieved sometime after the child is walking. The child must be able to recognize the urge to let go and to hold on. The child must want to please parent by holding on rather than pleasing self by letting go. Bowel training precedes bladder training. Watching older siblings provides role modeling and facilitates imitation for the toddler. The child should be introduced to the potty chair or toilet in a nonthreatening manner.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 564

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Health Promotion and Maintenance

 

  1. The parents of a newborn say that their toddler hates the baby. . . . He suggested that we put him in the trash can so the trash truck could take him away. The nurses best reply is which of the following?
a. Lets see if we can figure out why he hates the new baby.
b. Thats a strong statement to come from such a small boy.
c. Lets refer him to counseling to work this hatred out. Its not a normal response.
d. That is a normal response to the birth of a sibling. Lets look at ways to deal with this.

 

 

ANS:  D

The arrival of a new infant represents a crisis for even the best-prepared toddler. Toddlers have their entire schedule and routines disrupted because of the new family member. The nurse should work with parents on ways to involve the toddler in the newborns care and to help focus attention on the toddler. The toddler does not hate the infant. This is an expected, normal response to the changes in routines and attention that affect the toddler. The toddler can be provided with a doll to imitate parents behaviors. The child can care for the dolls needs at the same time the parent is performing similar care for the newborn.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 567

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Psychosocial Integrity

 

  1. A toddlers parent asks the nurse for suggestions on dealing with temper tantrums. Which of the following is the most appropriate recommendation?
a. Punish the child.
b. Explain to child that this is wrong.
c. Leave the child alone until the tantrum is over.
d. Remain close by the child but without eye contact.

 

 

ANS:  D

The best way to deal with temper tantrums is to ignore the behaviors, provided that the actions are not dangerous to the child. Tantrums are common during this age-group as the child becomes more independent and overwhelmed by increasingly complex tasks. The parents and caregivers need to have consistent and developmentally appropriate expectations. Punishment and explanations will not be beneficial. The presence of the parent is necessary both for safety and to provide a feeling of control and security to the child when the tantrum is over.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 563

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Health Promotion and Maintenance

 

  1. A parent asks the nurse about negativism in toddlers. The most appropriate recommendation is which of the following?
a. Punish the child.
b. Provide more attention.
c. Ask child not to always say no.
d. Reduce the opportunities for a no answer.

 

 

ANS:  D

The nurse should suggest to the parent that questions should be phrased with realistic choices rather than yes or no answers. This provides a sense of control for the toddler and reduces the opportunity for negativism. Negativism is not an indication of stubbornness or insolence and should not be punished. The negativism is not a function of attention; the child is testing limits to gain an understanding of the world. The toddler is too young to comply with requests not to say no.

 

DIF:    Cognitive Level: Analysis               REF:   p. 568

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Health Promotion and Maintenance

 

  1. The parents of a 2-year-old tell the nurse they are concerned because the toddler has started to use baby talk since the arrival of their new baby. The nurse should recommend which of the following?
a. Ignore the baby talk.
b. Tell the toddler frequently, You are a big kid now.
c. Explain to the toddler that baby talk is for babies.
d. Encourage the toddler to practice more advanced patterns of speech.

 

 

ANS:  A

The baby talk is a sign of regression in the toddler. Often toddlers attempt to cope with a stressful situation by reverting to patterns of behavior that were successful in earlier stages of development. It should be ignored, while praising the child for developmentally appropriate behaviors. Regression is childrens way of expressing stress. The parents should not introduce new expectations and allow the child to master the developmental tasks without criticism.

 

DIF:    Cognitive Level: Application          REF:   p. 569

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Health Promotion and Maintenance

 

  1. Parents tell the nurse that their toddler eats little at mealtime, only sits at the table with the family briefly, and wants snacks all the time. Which of the following should the nurse recommend?
a. Give her nutritious snacks.
b. Offer rewards for eating at mealtimes.
c. Avoid snacks so she is hungry at mealtimes.
d. Explain to her in a firm manner what is expected of her.

 

 

ANS:  A

Most toddlers exhibit a physiologic anorexia in response to the decreased nutritional requirement associated with the slower growth rate. Parents should assist the child in developing healthy eating habits. The toddler is often unable to sit through a meal. Frequent nutritious snacks are a good way to ensure proper nutrition. To help with developing healthy eating habits, food should be not be used as positive or negative reinforcement for behavior. The child may develop habits of overeating or eat nonnutritious foods in response. A toddler is not able to understand explanations of what is expected of her and comply with the expectations.

 

DIF:    Cognitive Level: Application          REF:   p. 571

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Health Promotion and Maintenance

 

  1. A father tells the nurse that his daughter wants the same plate and cup used at every meal, even if they go to a restaurant. The nurse should explain that this is which of the following?
a. A sign the child is spoiled
b. An attempt to exert unhealthy control
c. Regression, which is common at this age
d. Ritualism, an expected behavior at this age

 

 

ANS:  D

The child is exhibiting the ritualism that is characteristic at this age. Ritualism is the need to maintain the sameness and reliability. It provides a sense of structure and comfort to the toddler. It will dictate certain principles in feeding practices, including rejecting a favorite food because it is served in a different container. This does not indicate the child has unreasonable expectations, but rather is part of normal development. Ritualism is not regression, which is a retreat from a present pattern of functioning.

 

DIF:    Cognitive Level: Analysis               REF:   p. 556

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Health Promotion and Maintenance

 

  1. The nurse is discussing with a parent group the importance of fluoride for healthy teeth. Which of the following should the nurse recommend?
a. Determine whether water supply is fluoridated.
b. Use fluoridated mouth rinses in children older than 1 year.
c. Give fluoride supplements to infants beginning at age 2 months.
d. Brush teeth with fluoridated toothpaste unless fluoride content of water supply is adequate.

 

 

ANS:  A

The decision about fluoride supplementation cannot be made until it is known whether the water supply contains fluoride and the amount. It is difficult to teach toddlers to spit out the mouthwash. Swallowing fluoridated mouthwashes can contribute to fluorosis. Fluoride supplementation is not recommended until after age 6 months and then only if the water is not fluoridated. Fluoridated toothpaste is still indicated if the fluoride content of the water supply is adequate, but very small amounts are used.

 

DIF:    Cognitive Level: Analysis               REF:   p. 573

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Health Promotion and Maintenance

 

  1. Which of the following is an appropriate recommendation in preventing tooth decay in young children?
a. Substitute raisins for candy.
b. Substitute sugarless gum for regular gum.
c. Use honey or molasses instead of refined sugar.
d. When sweets are to be eaten, select a time not during meals.

 

 

ANS:  B

Regular gum has high sugar content. When the child chews gum, the sugar is in prolonged contact with the teeth. Sugarless gum is less cariogenic than regular gum. Raisins, honey, and molasses are highly cariogenic and should be avoided. Sweets should be consumed with meals so that the teeth can be cleaned afterward. This decreases the amount of time that the sugar is in contact with the teeth.

 

DIF:    Cognitive Level: Analysis               REF:   p. 575

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Health Promotion and Maintenance

 

  1. What is the leading cause of death during the toddler period?
a. Injuries
b. Infectious diseases
c. Childhood diseases
d. Congenital disorders

 

 

ANS:  A

Injuries are the most common cause of death in children ages 1 through 4 years. It is the highest rate of death from injuries of any childhood age-group except adolescence. Congenital disorders are the second leading cause of death in this age-group. Infectious and childhood diseases are less common causes of death in this age-group.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 575            TOP:   Nursing Process: Planning

MSC:  Client Needs: Health Promotion and Maintenance

 

  1. The parent of 16-month-old Brian asks, What is the best way to keep Brian from getting into our medicines at home? The nurse should advise which of the following?
a. All medicines should be locked securely away.
b. The medicines should be placed in high cabinets.
c. Brian just needs to be taught not to touch medicines.
d. Medicines should not be kept in the homes of small children.

 

 

ANS:  A

The major reason for poisoning in the home is improper storage. Toddlers can climb, unlatch cabinets, and obtain access to high-security places. For medications, only a locked cabinet is safe. Toddlers can climb using furniture. High places are not a deterrent to an exploring toddler. Toddlers are not able to generalize that all the different forms of medications in the home may be dangerous. Keeping medicines out of the homes of small children is not feasible. Many parents require medications for chronic or acute illnesses. Parents must be taught safe storage for their home and when they visit other homes.

 

DIF:    Cognitive Level: Application          REF:   p. 580

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Health Promotion and Maintenance

 

  1. A toddlers parents have been using a rear-facing convertible car seat since she was born. The seat can be safely switched to the forward-facing position when she weighs how many pounds?
a. 10
b. 20
c. 30
d. 40

 

 

ANS:  B

Although the transition point for switching to the forward-facing position is defined by the manufacturer, it is generally at 9 kg (20 lb); 4.5 kg (10 lb) is too small to be safe. Because of the relatively large head, this size child should be in the rear-facing position. It is usually safe to put children who weigh more than 20 lb in forward-facing convertible safety seats.

 

DIF:    Cognitive Level: Analysis               REF:   p. 576

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Health Promotion and Maintenance

 

  1. The most common type of burn in the toddler age-group is:
a. electric burn from electrical outlets.
b. flame burn from playing with matches.
c. hot object burn from cigarettes or irons.
d. scald burn from high-temperature tap water.

 

 

ANS:  D

Scald burns are the most common type of thermal injury in children, especially 1- and 2-year-olds. Temperature should be reduced on the hot water in the house and hot liquids placed out of the childs reach. Electric burns from electrical outlets and hot object burns from cigarettes or irons are both significant causes of burn injury. The child should be protected by reducing the temperature on the hot water heater in the home, keeping objects such as cigarettes and irons away from children, and placing protective guards over electrical outlets when not in use. Flame burns from matches and lighters represent one of the most fatal types of burns in the toddler age-group, but not one of the most common types of burn.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 580            TOP:   Nursing Process: Planning

MSC:  Client Needs: Health Promotion and Maintenance

 

  1. The nurse is assessing a 20-month-old toddler during a well-child visit and notices tooth decay. The nurse should understand that early childhood caries are caused by which of the following?
a. Allowing the child to eat citrus foods at bedtime
b. A hereditary factor that cannot be prevented
c. Poor fluoride supply in the drinking water
d. Giving the child a bottle of juice or milk at naptime

 

 

ANS:  D

One cause of early childhood caries is allowing the child to go to sleep with a bottle of milk or juice; as the sweet liquid pools in the mouth, the teeth are bathed for several hours in this cariogenic environment. Eating citrus fruit at bedtime and poor fluoride supply in drinking water do not cause early childhood caries. The problem is not hereditary and can be prevented with proper education.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 575

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Health Promotion and Maintenance

 

  1. The nurse is providing guidance strategies to a group of parents with toddlers at a community outreach program. Which of the following statements by a parent would indicate a correct understanding of the teaching?
a. I should expect my 24-month-old child to express some signs of readiness for toilet training.
b. I should be firm and structured when disciplining my 18-month-old child.
c. I should expect my 12-month-old child to start to develop a fear of darkness and to need a security blanket.
d. I should expect my 36-month-old child to understand time and proximity of events.

 

 

ANS:  A

A 24-month-old toddler starts to show readiness for toilet training; it is important for the parent to be aware of this and be ready to start the process. At 18 months of age, a child needs consistent but gentle discipline, since the child cannot yet understand firmness and structure with discipline. Development of fears and need for security items usually occurs at the end of the 18- to 24-month stage. A 36-month-old child does not yet understand time and proximity of events, so the parent needs to understand that the toddler cannot hurry up or we will be late.

 

DIF:    Cognitive Level: Application          REF:   p. 582

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Health Promotion and Maintenance

 

MULTIPLE RESPONSE

 

  1. The nurse is preparing a staff education program about growth and development of an 18-month-old toddler. Which of the following characteristics should the nurse include in the staff education program? Select all that apply.
a. Eats well with a spoon and cup
b. Runs clumsily and can walk up stairs
c. Points to common objects
d. Builds a tower of three or four blocks
e. Has a vocabulary of 300 words
f. Dresses self in simple clothes

 

 

ANS:  A, B, C, D

Tasks accomplished by an 18-month-old toddler include eating well with a spoon and cup, running clumsily, walking up stairs, pointing to common objects such as shoes, and building a tower with three or four blocks. An 18-month-old toddler has a vocabulary of only 10 words, not 300. Toddlers cannot dress themselves in simple clothing until 24 months of age.

 

DIF:    Cognitive Level: Application          REF:   pp. 562, 564

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Health Promotion and Maintenance

 

Hockenberry: Wongs Nursing Care of Infants and Children, 9th Edition

 

Chapter 28: Balance and Imbalance of Body Fluids

 

Test Bank

 

MULTIPLE CHOICE

 

  1. Which of the following is released from the posterior pituitary gland and promotes water retention in the renal system?
a. Renin
b. Aldosterone
c. Angiotensin
d. Antidiuretic hormone (ADH)

 

 

ANS:  D

ADH is released in response to increased osmolality and decreased volume of intravascular fluid; it promotes water retention in the renal system by increasing the permeability of renal tubules to water. Renin release is stimulated by diminished blood flow to the kidneys. Aldosterone is secreted by the adrenal cortex. It enhances sodium reabsorption in renal tubules, promoting osmotic reabsorption of water. Renin reacts with a plasma globulin to generate angiotensin, which is a powerful vasoconstrictor. Angiotensin also stimulates the release of aldosterone.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 1055

TOP:   Nursing Process: Assessment

MSC:  Client Needs: Physiological Integrity: Physiologic Adaptation

 

  1. Nurses must be alert for increased fluid requirements when a child has which of the following?
a. Fever
b. Mechanical ventilation
c. Congestive heart failure
d. Increased intracranial pressure

 

 

ANS:  A

Fever leads to great insensible fluid loss in young children because of increased body surface area relative to fluid volume. The mechanically ventilated child has decreased fluid requirements. Congestive heart failure is a case of fluid overload in children. Increased intracranial pressure does not lead to increased fluid requirements in children.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 1055

TOP:   Nursing Process: Assessment

MSC:  Client Needs: Physiological Integrity: Reduction of Risk Potential

 

  1. Which of the following factors predisposes an infant to fluid imbalances?
a. Decreased surface area
b. Lower metabolic rate
c. Immature kidney functioning
d. Decreased daily exchange of extracellular fluid

 

 

ANS:  C

The infants kidneys are functionally immature at birth and are inefficient in excreting waste products of metabolism. Infants have a relatively high body surface area (BSA) compared with adults. This allows a higher loss of fluid to the environment. A higher metabolic rate is present as a result of the higher BSA in relation to active metabolic tissue. The higher metabolic rate increases heat production, which results in greater insensible water loss. Infants have a greater exchange of extracellular fluid, leaving them with a reduced fluid reserve in conditions of dehydration.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 1055

TOP:   Nursing Process: Assessment

MSC:  Client Needs: Physiological Integrity: Physiologic Adaptation

 

  1. The number of milliliters of fluid per day needed for a 14 kg child is:
a. 800
b. 1000
c. 1200
d. 1400

 

 

ANS:  C

For the first 10 kg of body weight a child requires 100 ml/kg. For each additional kilogram of body weight an extra 50 ml is needed.

10 kg 100 ml/kg/day = 1000 ml

4 kg 50 ml/kg/day = 200 ml

1000 ml + 200 ml = 1200 ml/day

Eight hundred to 1000 ml is too little; 1400 ml is too much.

 

DIF:    Cognitive Level: Application          REF:   p. 1055

TOP:   Nursing Process: Assessment

MSC:  Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. An infant is brought to the emergency department with the following clinical manifestations: poor skin turgor, weight loss, lethargy, tachycardia, and tachypnea. This is suggestive of which of the following?
a. Water excess
b. Sodium excess
c. Water depletion
d. Potassium excess

 

 

ANS:  C

These clinical manifestations indicate water depletion or dehydration. Edema and weight gain occur with water excess or overhydration. Sodium or potassium excess would not cause these symptoms.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 1056

TOP:   Nursing Process: Assessment

MSC:  Client Needs: Physiological Integrity: Reduction of Risk Potential

 

  1. Clinical manifestations of sodium excess (hypernatremia) include which of the following?
a. Hyperreflexia
b. Abdominal cramps
c. Cardiac dysrhythmias
d. Dry, sticky mucous membranes

 

 

ANS:  D

Dry, sticky mucous membranes are associated with hypernatremia. Hyperreflexia is associated with hyperkalemia. Abdominal cramps, weakness, dizziness, nausea, and apprehension are associated hyponatremia. Cardiac dysrhythmias are associated with hypokalemia.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 1057

TOP:   Nursing Process: Assessment

MSC:  Client Needs: Physiological Integrity: Physiologic Adaptation

 

  1. Which of the following laboratory findings would the nurse expect in a child with an excess of water?
a. Decreased hematocrit
b. High serum osmolality
c. High urine specific gravity
d. Increased blood urea nitrogen

 

 

ANS:  A

The excess water in the circulatory system results in hemodilution. The laboratory results show a falsely decreased hematocrit. Laboratory analysis of blood that is hemodiluted reveals decreased serum osmolality and blood urea nitrogen. The urine specific gravity is variable relative to the childs ability to correct the fluid imbalance.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 1056

TOP:   Nursing Process: Assessment

MSC:  Client Needs: Physiological Integrity: Reduction of Risk Potential

 

  1. Which of the following is a clinical manifestation of calcium depletion (hypocalcemia)?
a. Nausea, vomiting
b. Weakness, fatigue
c. Muscle hypotonicity
d. Neuromuscular irritability

 

 

ANS:  D

Neuromuscular irritability is a clinical manifestation of hypocalcemia. Nausea and vomiting occur with hypercalcemia and hypernatremia. Weakness, fatigue, and muscle hypotonicity are clinical manifestations of hypercalcemia.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 1058

TOP:   Nursing Process: Assessment

MSC:  Client Needs: Physiological Integrity: Reduction of Risk Potential

 

  1. What type of dehydration occurs when the electrolyte deficit exceeds the water deficit?
a. Isotonic dehydration
b. Hypotonic dehydration
c. Hypertonic dehydration
d. Hyperosmotic dehydration

 

 

ANS:  B

Hypotonic dehydration occurs when the electrolyte deficit exceeds the water deficit, leaving the serum hypotonic. Isotonic dehydration occurs in conditions in which electrolyte and water deficits are present in balanced proportion. Hypertonic dehydration results from water loss in excess of electrolyte loss. This is the most dangerous type of dehydration. It is caused by feeding children fluids with high amounts of solute. Hyperosmotic dehydration is another term for hypertonic dehydrat

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