Nursing Care of Children Principles and Practice 3rd edition by Susan R. James – Test Bank

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Nursing Care Of Children  Principles and Practice 3rd edition by Susan R. James – Test Bank

 

 Sample  Questions

 

James: Nursing Care of Children: Principles and Practice, 3rd Edition

Test Bank

Chapter 06: Health Promotion During Early Childhood

MULTIPLE CHOICE

 

  1. The mother of a 14-month-old child is concerned because the child’s appetite has decreased. The best response for the nurse to make to the mother is:
a. “It is important for your toddler to eat three meals a day and nothing in between.”
b. “It is not unusual for toddlers to eat less.”
c. “Be sure to increase your child’s milk consumption, which will improve nutrition.”
d. “Giving your child a multivitamin supplement daily will increase your toddler’s appetite.”

 

 

ANS:   B

 

  Feedback
A Toddlers need small, frequent meals. Nutritious selection throughout the day, rather than quantity, is more important with this age group.
B Physiologically, growth slows and appetite decreases during the toddler period.
C Milk consumption should not exceed 24 to 32 ounces daily. Increasing the amount of milk will only further decrease solid food intake.
D Supplemental vitamins are important for all children, but they do not increase appetite.

 

 

DIF:    Cognitive Level: Application             REF:    Text Reference: pg 147

OBJ:    Nursing Process Step: Implementation

MSC:   NCLEX: Physiological Integrity

 

  1. Which of the following toys is the most developmentally appropriate for an 18- to 24-month-old child?
a. A push and pull toy
b. Nesting blocks
c. A bicycle with training wheels
d. A computer

 

 

ANS:   A

 

  Feedback
A Push and pull toys encourage large muscle activity and are appropriate for the child between 18 and 24 months of age.
B Nesting blocks are more appropriate for a 12- to 15-month-old child.
C A bicycle with training wheels is appropriate for a preschool or young school-age child.
D A computer can be appropriate as early as the preschool years.

 

 

DIF:    Cognitive Level: Comprehension       REF:    Text Reference: pg 145

OBJ:    Nursing Process Step: Assessment

MSC:   NCLEX: Health Promotion and Maintenance

 

  1. Which of the following is the priority concern in developing a teaching plan for the parents of a 15-month-old child?
a. Toilet training guidelines
b. Guidelines for weaning children from bottles
c. Instructions on preschool readiness
d. Instructions on a home safety assessment

 

 

ANS:   D

 

  Feedback
A Although it is appropriate to give parents of a 15-month-old child toilet training guidelines, the child is not usually ready for toilet training, so it is not the priority teaching intervention.
B Parents of a 15-month-old child should have been advised to beginning weaning from the breast or bottle at 6 to 12 months of age.
C Educating a parent about preschool readiness is important and can occur later in the parents’ educational process. The priority teaching intervention for the parents of a 15-month-old child is the importance of a safe environment.
D Accidents are the major cause of death in children, including deaths caused by ingestion of poisonous materials. Home and environmental safety assessments are priorities in this age group because of toddlers’ increased mobility, which puts them at greater risk in an unsafe environment.

 

 

DIF:    Cognitive Level: Application             REF:    Text Reference: pgs 135-136, 139

OBJ:    Nursing Process Step: Planning

MSC:   NCLEX: Health Promotion and Maintenance

 

  1. What is the primary purpose of a transitional object?
a. It helps the parents deal with the guilt they feel when they leave the child.
b. It keeps the child quiet at bedtime.
c. It is effective in decreasing anxiety in the toddler.
d. It decreases negativism and tantrums in the toddler.

 

 

ANS:   C

 

  Feedback
A A decrease in parental guilt (distress) is an indirect benefit of a transitional object.
B A transitional object may be part of a bedtime ritual, but it may not keep the child quiet at bedtime.
C Decreasing anxiety, particularly separation anxiety, is the function of a transitional object; it provides comfort to the toddler in stressful situations and helps make the transition from dependence to autonomy.
D A transitional object does not significantly affect negativity and tantrums, but it can comfort a child after tantrums.

 

 

DIF:    Cognitive Level: Comprehension       REF:    Text Reference: pg 144

OBJ:    Nursing Process Step: Implementation

MSC:   NCLEX: Health Promotion and Maintenance

 

  1. Which of the following statements best identifies the characteristics of language development in a toddler?
a. Language development skills slow during the toddler period.
b. The toddler understands more than he can express.
c. Most of the toddler’s speech is not easily understood.
d. The toddler’s vocabulary contains approximately 600 words.

 

 

ANS:   B

 

  Feedback
A Although language development varies in relationship to physical activity, language skills are rapidly accelerating by 15 to 24 months of age.
B The toddler’s ability to understand language (receptive language) exceeds the child’s ability to speak it (expressive language).
C By 2 years of age, 60% to 70% of the toddler’s speech is understandable.
D The toddler’s vocabulary contains approximately 300 or more words.

 

 

DIF:    Cognitive Level: Knowledge             REF:    Text Reference: pg 141

OBJ:    Nursing Process Step: Assessment

MSC:   NCLEX: Health Promotion and Maintenance

 

  1. When is toilet training most appropriately initiated?
a. When the child is 18 months of age
b. When the child exhibits signs of physical and psychologic readiness
c. When the child has been walking for 9 months
d. When the child is able to sit on the “potty” for 10 to 15 minutes

 

 

ANS:   B

 

  Feedback
A Toilet training is not arbitrarily started at 18 months of age. The child needs to demonstrate signs of bowel or bladder control before attempting toilet training. Waiting until 24 to 30 months of age makes the task easier; toddlers are less negative, more willing to control their sphincters, and want to please their parents.
B Neurologic development is completed at approximately 18 months of age. Parents need to know that both physical and psychologic readiness are necessary for toilet training to be successful.
C One of the physical signs of readiness for toilet training is that the child has been walking for 1 year.
D The ability to sit on the “potty” 10 to 15 minutes may demonstrate parental control rather than being a sign of developmental readiness for toilet training.

 

 

DIF:    Cognitive Level: Knowledge             REF:    Text Reference: pg 156

OBJ:    Nursing Process Step: Assessment

MSC:   NCLEX: Health Promotion and Maintenance

 

  1. Which of the following statements by a mother of a toddler indicates a correct understanding of the use of discipline?
a. “I always include explanations and morals when I am disciplining my toddler.”
b. “I always try to be consistent when disciplining the children, and I correct my children at the time they are misbehaving.”
c. “I believe that discipline should only be done by one family member.”
d. “My rule of thumb is no more than one spanking a day.”

 

 

ANS:   B

 

  Feedback
A The toddler’s cognitive level of development precludes the use of explanations and morals as a part of discipline.
B Consistent and immediate discipline for toddlers is the most effective approach. Unless disciplined immediately, the toddler will have difficulty connecting the discipline with the behavior.
C Discipline for the toddler should be immediate; therefore, the family member caring for the child should provide discipline to the toddler when it is necessary.
D Discipline is required for unacceptable behavior, and the one-spanking-a-day rule contradicts the concept of a consistent response to inappropriate behavior. Additionally, spanking is an inappropriate method of disciplining a child.

 

 

DIF:    Cognitive Level: Comprehension       REF:    Text Reference: pg 151

OBJ:    Nursing Process Step: Implementation

MSC:   NCLEX: Health Promotion and Maintenance

 

  1. Which of the following comments indicates that the mother of a toddler needs further teaching about dental care?
a. “We use well water so I give my toddler fluoride supplements.”
b. “My toddler brushes his teeth with my help.”
c. “My child will not need a dental checkup until his permanent teeth come in.”
d. “I use a small nylon bristle brush for my toddler’s teeth.”

 

 

ANS:   C

 

  Feedback
A Toddlers need fluoride supplements when they use a water supply that is not fluorinated.
B Toddlers need supervision with dental care. The parent should finish brushing areas not reached by the child.
C Children should first see the dentist 6 months after the first primary tooth erupts and no later than age 30 months.
D A small nylon bristle brush works best for cleaning toddlers’ teeth.

 

 

DIF:    Cognitive Level: Comprehension       REF:    Text Reference: pg 149

OBJ:    Nursing Process Step: Evaluation      MSC:   NCLEX: Physiological Integrity

 

  1. Which assessment finding in a preschooler would suggest the need for further investigation?
a. The child is able to dress independently.
b. The child rides a tricycle.
c. The child has an imaginary friend.
d. The child has a 2-pound weight gain in 12 months.

 

 

ANS:   D

 

  Feedback
A A preschool child should be able to dress independently.
B A preschool child should be able to ride a tricycle.
C Imaginary friends are common for preschoolers.
D Preschool children gain an average of 5 pounds a year. A gain of only 2 pounds is less than half of the expected weight gain and should be investigated.

 

 

DIF:    Cognitive Level: Knowledge             REF:    Text Reference: pg 137

OBJ:    Nursing Process Step: Evaluation

MSC:   NCLEX: Health Promotion and Maintenance

 

  1. Which is the most appropriate action for the nurse to take when telling a preschool child about an upcoming procedure?
a. Explain all the information in detail to the child.
b. Speak loudly and clearly to the child.
c. Inform the parents of the procedure and ask them to tell the child.
d. Use symbolic play to explain the procedure.

 

 

ANS:   D

 

  Feedback
A It is inappropriate to give a preschooler all the information in detail. The child needs to understand what is going to happen to him without explicit details of the procedure.
B Speaking in clear sentences with simple words is important, but the conversation should be conducted at a nonthreatening normal sound level.
C The nurse has the most knowledge and best ability for explaining the procedure to the child; however, the parents can be an important resource when explaining the procedure.
D Symbolic play is important for emotional development because it allows the child to work through distressing feelings and can be therapeutic.

 

 

DIF:    Cognitive Level: Comprehension       REF:    Text Reference: pg 140

OBJ:    Nursing Process Step: Implementation

MSC:   NCLEX: Health Promotion and Maintenance

 

  1. In caring for a 4-year-old child with a diagnosis of suspected child abuse, which is the best nursing intervention?
a. Avoid touching the child.
b. Provide the child with play situations that allow for disclosure.
c. Discourage the child from remembering the incident.
d. Deny the suspected perpetrator visiting rights to the child.

 

 

ANS:   B

 

  Feedback
A All children need to be touched. What is important is to tell the child in simple, clear terms what you are doing and why you are doing it. Nurses have the opportunity to teach children the normal, healthy boundaries of their bodies and what constitutes inappropriate behavior.
B Play allows the child to disclose what happened to him or her without having to talk about the incident. Symbolic play is important for emotional development and it allows the child to work through distressing feelings.
C If the child chooses to remember what happened, it is inappropriate to discourage it. It is important to listen to the child in a nonjudgmental way, allowing the child to discuss what happened, to make statements, or to ask questions.
D It is not the nurse’s role or responsibility to restrict visitors unless child safety is an issue. The child may be negatively affected if a caregiver, who may be the abuser, does not visit.

 

 

DIF:    Cognitive Level: Application             REF:    Text Reference: pg 140

OBJ:    Nursing Process Step: Implementation

MSC:   NCLEX: Psychosocial Integrity

 

  1. Which of following is helpful to tell a mother who is concerned about preventing sleep problems in her preschool child?
a. Have the child always sleep in a quiet, darkened room.
b. Provide high-carbohydrate snacks before bedtime.
c. Communicate with the child’s daytime caretaker to encourage a longer nap
d. Use a night light in the child’s room.

 

 

ANS:   D

 

  Feedback
A A dark, quiet room may be scary to a preschooler.
B High-carbohydrate snacks increase energy and do not promote relaxation.
C Taking a longer nap during the day will not cause the child to sleep longer at night. A child who has slept for a long time at the babysitter’s may not be ready to sleep again.
D The preschooler has a great imagination. Sounds and shadows can have a negative effect on sleeping behavior. Night lights provide the child with the ability to visualize the environment and decrease the fear felt in a dark room.

 

 

DIF:    Cognitive Level: Application             REF:    Text Reference: pg 150

OBJ:    Nursing Process Step: Implementation

MSC:   NCLEX: Physiological Integrity

 

  1. Which of the following statements is true about the care of the preschooler’s teeth?
a. Because deciduous teeth are not permanent, they are not important to the child.
b. Children can be encouraged to brush their teeth after the teeth have been thoroughly cleaned by the parent.
c. Secondary tooth eruption begins at 4 to 5 years of age.
d. Fluoride supplements can be discontinued when the secondary teeth erupt.

 

 

ANS:   B

 

  Feedback
A Deciduous teeth are important because they maintain spacing and play an important role in the growth and development of the jaws and face and in speech development.
B Toddlers and preschoolers lack the manual dexterity to remove plaque adequately, so parents must assume this responsibility.
C Secondary teeth erupt at about 6 years of age.
D If the family does not live in an area where fluoride is included in the water supply, fluoride supplements should be continued.

 

 

DIF:    Cognitive Level: Knowledge             REF:    Text Reference: pg 149

OBJ:    Nursing Process Step: Planning         MSC:   NCLEX: Physiological Integrity

 

  1. What do parents of preschool children need to understand about discipline?
a. Both parents and the child should agree on the method of discipline.
b. Discipline should involve some physical restriction.
c. The method of discipline should be consistent with the discipline methods of the child’s peers.
d. Discipline should include positive reinforcement of desired behaviors.

 

 

ANS:   D

 

  Feedback
A Discipline does not need to be agreed on by the child. Both parents should be in agreement so the discipline is consistently applied.
B Discipline does not necessarily need to include physical restriction.
C Discipline does not need to be consistent with that of the child’s peers.
D Effective discipline strategies should involve a comprehensive approach that includes consideration of the parent-child relationship, reinforcement of desired behaviors, and consequences for negative behaviors.

 

 

DIF:    Cognitive Level: Comprehension       REF:    Text Reference: pg 150

OBJ:    Nursing Process Step: Planning

MSC:   NCLEX: Health Promotion and Maintenance

 

  1. Which of the following is a critical factor in preparing a child for kindergarten entry?
a. The child’s ability to sit still
b. The child’s sense of learned helplessness
c. The parent’s interactions and responsiveness to the child
d. Attending a preschool program

 

 

ANS:   C

 

  Feedback
A The child’s ability to sit still is important to learning; however, parental responsiveness and involvement are more important factors.
B Learned helplessness is the result of a child feeling that he has no effect on the environment and his actions do not matter. Parents who are actively involved in a supportive learning environment will demonstrate a more positive approach to learning.
C Interactions between the parent and child are an important factor in the development of academic competence. Parent encouragement and support maximizes a child’s potential.
D Preschool and day care programs can supplement the developmental opportunities provided by parents at home, but they are not critical in preparing a child for entering kindergarten.

 

 

DIF:    Cognitive Level: Knowledge             REF:    Text Reference: pg 160

OBJ:    Nursing Process Step: Assessment

MSC:   NCLEX: Health Promotion and Maintenance

 

MULTIPLE RESPONSE

 

  1. Which play patterns does a 3-year-old child typically display? Select all that apply.
a. Imaginary play
b. Parallel play
c. Cooperative play
d. Structured play

 

 

ANS:   A, B, C

 

  Feedback
Correct A., B., C. Children between the ages of 3 and 5 years enjoy parallel and associative play. Children learn to share and cooperate as they play in small groups. Play is often imitative, dramatic, and creative. Imaginary friends are common near the age of 3 years.
Incorrect D. Structured play is typical of school-age children.

 

 

DIF:    Cognitive Level: Knowledge             REF:    Text Reference: pg 146

OBJ:    Nursing Process Step: Assessment

MSC:   NCLEX: Health Promotion and Maintenance

 

 

James: Nursing Care of Children: Principles and Practice, 3rd Edition

Test Bank

Chapter 07: Health Promotion for the School Age Child

MULTIPLE CHOICE

 

  1. Which of the following statements made by a mother of a school-age boy indicates a need for further teaching?
a. “My child is playing soccer this year.”
b. “He is always busy with his friends playing games. He is very active.”
c. “I limit his television watching to about 2 hours a day.”
d. “I am glad his coach is a good role model. He emphasizes the importance of winning in today’s society. The kids really are disciplined.”

 

 

ANS:   D

 

  Feedback
A Team sports such as soccer are appropriate for exercise and refinement of motor skills.
B School-age children need to participate in physical activities, which contribute to their physical fitness skills and well-being.
C Limiting television to 2 hours a day is an appropriate restriction. School-age children should be encouraged to participate in physical activities.
D Team sports are important for the development of sportsmanship and teamwork and for exercise and refinement of motor skills. A coach who emphasizes winning and strict discipline is not appropriate for children in this age group.

 

 

DIF:    Cognitive Level: Evaluation              REF:    Text Reference: pg 167

OBJ:    Nursing Process Step: Assessment

MSC:   NCLEX: Health Promotion and Maintenance

 

  1. Which of the following behaviors is not demonstrated in the school-age child?
a. Experiments with profanity and dirty jokes
b. Laughs at silly jokes and enjoys using words
c. Understands that pouring liquid from a small to large container does not change the amount
d. Engages in fantasy and magical thinking

 

 

ANS:   D

 

  Feedback
A The school-age child goes through a period in which profanity and dirty jokes are explored. This behavior is not unusual for the school-age child.
B The school-age child has a sense of humor. His increased language mastery and increased logic allow for appreciation of plays on words, jokes, and incongruities.
C The school-age child understands that properties of objects do not change when their order, form, or appearance does.
D The preschool child engages in fantasy and magical thinking. The school-age child moves away from this type of thinking and becomes more skeptical and logical. Belief in Santa Claus or the Easter Bunny ends in this period of development.

 

 

DIF:    Cognitive Level: Analysis                  REF:    Text Reference: pg 168

OBJ:    Nursing Process Step: Assessment

MSC:   NCLEX: Health Promotion and Maintenance

 

  1. The ability to mentally understand that 1 + 3 = 4 and 4 – 1 = 3 occurs in which stage of cognitive development?
a. Concrete operations stage
b. Formal operations stage
c. Intuitive thought stage
d. Preoperations stage

 

 

ANS:   A

 

  Feedback
A By 7 to 8 years of age, the child is able to retrace a process (reversibility) and has the skills necessary for solving mathematical problems. This stage is called concrete operations.
B The formal operations stage deals with abstract reasoning and does not occur until adolescence.
C Thinking in the intuitive stage is based on immediate perceptions. A child in this stage often solves problems by random guessing.
D In preoperational thinking, the child is usually able to add 1 + 3 = 4 but is unable to retrace the process

 

 

DIF:    Cognitive Level: Knowledge             REF:    Text Reference: pg 168

OBJ:    Nursing Process Step: Assessment

MSC:   NCLEX: Health Promotion and Maintenance

 

  1. Which activity is most appropriate for developing fine motor skills in the school-age child?
a. Drawing
b. Singing
c. Soccer
d. Swimming

 

 

ANS:   A

 

  Feedback
A Activities such as drawing, building models, and playing a musical instrument increase the school-age child’s fine motor skills.
B Singing is an appropriate activity for the school-age child, but it does not increase fine motor skills.
C The school-age child needs to participate in group activities to increase both gross motor skills and social skills but group activities do not increase fine motor skills.
D Swimming is an activity that also increases gross motor skills.

 

 

DIF:    Cognitive Level: Analysis                  REF:    Text Reference: pg 168

OBJ:    Nursing Process Step: Evaluation

MSC:   NCLEX: Health Promotion and Maintenance

 

  1. Which of the following statements best describes growth in the early school-age period?
a. Boys grow faster than girls do.
b. Puberty occurs earlier in boys than in girls.
c. Puberty occurs at the same age for all races and ethnicities.
d. It is a period of rapid physical growth.

 

 

ANS:   A

 

  Feedback
A During the school-age developmental period, boys are approximately 1 inch taller and 2 pounds heavier than girls.
B Puberty occurs 1.5 to 2 years later in boys, which is developmentally later than puberty in girls (not unusual in 9- or 10-year-old girls).
C Puberty occurs approximately 1 year earlier in African American girls than white girls.
D Physical growth is slow and steady during the school-age years.

 

 

DIF:    Cognitive Level: Knowledge             REF:    Text Reference: pg 165

OBJ:    Nursing Process Step: Assessment

MSC:   NCLEX: Health Promotion and Maintenance

 

  1. The comment that is most developmentally typical of a 7-year-old boy is which of the following?
a. “I am a Power Ranger, so don’t make me angry.”
b. “I don’t know whether I like Mary or Joan better.”
c. “My mom is my favorite person in the world.”
d. “Jimmy is my best friend.”

 

 

ANS:   D

 

  Feedback
A Magical thinking is developmentally appropriate for the preschooler.
B Opposite-sex friendships are not typical for the 7-year-old child.
C Seven-year-old children socialize with their peers, not their parents.
D School-age children form friendships with peers of the same sex.

 

 

DIF:    Cognitive Level: Comprehension       REF:    Text Reference: pg 170

OBJ:    Nursing Process Step: Assessment

MSC:   NCLEX: Health Promotion and Maintenance

 

  1. Which of the following nursing actions is indicated for a 7-year-old child who uses appropriate vocabulary and frequently speaks about sex?
a. Ascertain what the child understands about sex.
b. Involve the child in teaching sex information to his peers.
c. Ask the child where he got this important information.
d. Ask the child if he was sexually abused.

 

 

ANS:   A

 

  Feedback
A School-age children often use correct vocabulary and yet have no real understanding of what the words mean.
B Having the child teach his peers about sex is an inappropriate action.
C Asking the child about his source of information is not particularly relevant.
D Asking direct questions about sexual abuse is not an appropriate action.

 

 

DIF:    Cognitive Level: Application             REF:    Text Reference: pg 168

OBJ:    Nursing Process Step: Implementation

MSC:   NCLEX: Health Promotion and Maintenance

 

  1. Identify the statement that is the most accurate about moral development in the 9-year-old school-age child.
a. Right and wrong are based on physical consequences of behavior.
b. The child obeys parents because of fear of punishment.
c. The school-age child conforms to rules to please others.
d. Parents are the determiners of right and wrong for the school-age child.

 

 

ANS:   C

 

  Feedback
A Children 4 to 7 years of age base right and wrong on consequences.
B Consequences are the most important consideration for the child between 4 to 7 years of age.
C The 7- to 12-year-old child bases right and wrong on a good-boy or good-girl orientation in which the child conforms to rules to please others and avoid disapproval
D Parents determine right and wrong for the child younger than 4 years of age.

 

 

DIF:    Cognitive Level: Knowledge             REF:    Text Reference: pg 170

OBJ:    Nursing Process Step: Assessment

MSC:   NCLEX: Health Promotion and Maintenance

 

  1. Which of the following parental behaviors is the most important in fostering moral development?
a. Telling the child what is right and wrong
b. Vigilantly monitoring the child and her peers
c. Weekly family meetings to discuss behavior
d. Living as the parents say they believe

 

 

ANS:   D

 

  Feedback
A Telling the child what is right and wrong is not effective unless the child has experienced what she hears. Parents need to live according to the values they are teaching to their children.
B Vigilant monitoring of the child and her peers is an inappropriate action for the parent to initiate. It does not foster moral development and reasoning in the child.
C Weekly family meetings to discuss behaviors may or may not be helpful in the development of moral reasoning.
D Parents living what they believe give nonambivalent messages and foster the child’s moral development and reasoning.

 

 

DIF:    Cognitive Level: Comprehension       REF:    Text Reference: pg 170

OBJ:    Nursing Process Step: Assessment

MSC:   NCLEX: Health Promotion and Maintenance

 

  1. Which of the following behaviors by parents or teachers will best assist the child in negotiating the developmental task of industry?
a. Identifying failures immediately and asking the child’s peers for feedback
b. Structuring the environment so the child can master tasks
c. Completing homework for children who are having difficulty in completing assignments
d. Decreasing expectations to eliminate potential failures

 

 

ANS:   B

 

  Feedback
A Asking peers for feedback reinforces the child’s feelings of failure.
B The task of the caring teacher or parent is to identify areas in which a child is competent and to build on successful experiences to foster feelings of mastery and success. Structuring the environment to enhance self-confidence and to provide the opportunity to solve increasingly more complex problems will promote a sense of mastery.
C When teachers or parents complete children’s homework for them, it sends the message that you do not trust them to do a good job. Providing assistance and suggestions and praising their best efforts are more appropriate.
D Decreasing expectations to eliminate failures will not promote a sense of achievement or mastery.

 

 

DIF:    Cognitive Level: Application             REF:    Text Reference: pg 169

OBJ:    Nursing Process Step: Implementation

MSC:   NCLEX: Health Promotion and Maintenance

 

  1. The older school-age child’s cognitive development can be evaluated by assessing which of the following?
a. The child’s addition and subtraction ability
b. The child’s ability to classify
c. The child’s vocabulary
d. The child’s play activity

 

 

ANS:   B

 

  Feedback
A Subtraction and addition are appropriate cognitive activities for the young school-age child.
B The ability to classify things from simple to complex and to identify differences and similarities are cognitive skills of the older school-age child; this demonstrates use of classification and logical thought processes.
C Vocabulary is not as valid an assessment of cognitive ability as is the child’s ability to classify.
D Play activity is not as valid an assessment of cognitive function as is the ability to classify.

 

 

DIF:    Cognitive Level: Knowledge             REF:    Text Reference: pg 168

OBJ:    Nursing Process Step: Evaluation

MSC:   NCLEX: Health Promotion and Maintenance

 

  1. Which of following is an appropriate disciplinary intervention for the school-age child?
a. Using time-out periods
b. Using a consequence that is consistent with the inappropriate behavior
c. Using physical punishment
d. Using lengthy dialog about inappropriate behavior

 

 

ANS:   B

 

  Feedback
A Time-out periods are more appropriate for younger children.
B A consequence that is related to the inappropriate behavior is the recommended discipline.
C Physical intervention is an inappropriate form of discipline. It does not connect the discipline with the child’s inappropriate behavior.
D Lengthy discussions typically are not helpful.

 

 

DIF:    Cognitive Level: Comprehension       REF:    Text Reference: pg 174

OBJ:    Nursing Process Step: Implementation

MSC:   NCLEX: Health Promotion and Maintenance

 

MULTIPLE RESPONSE

 

  1. Which of the following demonstrates the school-age child’s developing logic in the stage of concrete operations? Select all that apply.
a. The school-age child is able to recognize that 1 pound of feathers is equal to 1 pound of metal.
b. The school-age child is able to recognize that he can be a son, brother, or nephew at the same time.
c. The school-age child understands the principles of adding, subtracting, and reversibility.
d. The school-age child has thinking that is characterized by egocentrism, animism, and centration.

 

 

ANS:   A, B, C

 

  Feedback
Correct The school-age child understands that the properties of objects do not change when their order, form, or appearance does. Conservation occurs in the concrete operations stage. Comprehension of class inclusion occurs as the school-age child’s logic increases. The child begins to understand that a person can be in more than one class at the same time. This is characteristic of concrete thinking and logical reasoning. The school-age child is able to understand principles of adding, subtracting, and the process of reversibility, which occurs in the stage of concrete operations
Incorrect This type of thinking occurs in the intuitive thought stage, not the concrete operations stage of development.

 

 

DIF:    Cognitive Level: Knowledge             REF:    Text Reference: pg 168

OBJ:    Nursing Process Step: Evaluation

MSC:   NCLEX: Health Promotion and Maintenance

James: Nursing Care of Children: Principles and Practice, 3rd Edition

Test Bank

Chapter 11: The Ill Child in the Hospital and Other Care Settings

MULTIPLE CHOICE

 

  1. Which of the following situations poses the greatest challenge to the nurse working with a child and family?
a. Twenty-four hour observation
b. Emergency hospitalization
c. Outpatient admission
d. Rehabilitation admission

 

 

ANS:   B

 

  Feedback
A Although preparation time may be limited with a 24-hour observation, this situation does not usually involve the acuteness of the situation and the high levels of anxiety associated with emergency admission.
B Emergency hospitalization involves (1) limited time for preparation both for the child and family, (2) situations that cause fear for the family that the child may die or be permanently disabled, and (3) a high level of activity, which can foster further anxiety.
C Outpatient admission generally involves preparation time for family and child. Because of the lower level of acuteness in these settings, anxiety levels are not as high.
D Rehabilitation admission follows a serious illness or disease. This type of unit may resemble a home environment, which decreases the child and family’s anxiety.

 

 

DIF:    Cognitive Level: Comprehension       REF:    Text Reference: pg 285

OBJ:    Nursing Process Step: Planning

MSC:   NCLEX: Safe Effective Care Environment

 

  1. What is the primary disadvantage associated with outpatient and day facility care?
a. Increased cost
b. Increased risk of infection
c. Lack of physical connection to the hospital
d. Longer separation of the child from family

 

 

ANS:   C

 

  Feedback
A This type of care decreases cost.
B This type of care decreases risk of infection.
C Outpatient and day facility care do not provide extended care; therefore, a child requiring extended care would have to be transferred to the hospital, causing increased stress to the child and parents.
D This type of care minimizes separation of the child from family.

 

 

DIF:    Cognitive Level: Comprehension       REF:    Text Reference: pg 285

OBJ:    Nursing Process Step: Implementation

MSC:   NCLEX: Safe Effective Care Environment

 

  1. Which child would have the most difficulty with separation from family during hospitalization?
a. A 5-month-old infant
b. A 15-month-old toddler
c. A 4-year-old child
d. A 7-year-old child

 

 

ANS:   B

 

  Feedback
A Infants younger than 6 months of age will generally adapt to hospitalization if their basic needs for food, warmth, and comfort are met.
B Separation is the major stressor for children hospitalized between the ages of 6 and 30 months.
C Although separation anxiety occurs in hospitalized preschoolers, it is usually less obvious and less serious than that experienced by the toddler.
D The school-age child is accustomed to separation from parents. Although hospitalization is a stressor, the 7-year-old child will have less separation anxiety than a 15-month-old toddler.

 

 

DIF:    Cognitive Level: Knowledge             REF:    Text Reference: pg 288

OBJ:    Nursing Process Step: Assessment     MSC:   NCLEX: Psychosocial Integrity

 

  1. What is the best explanation for a 2-year-old child who is quiet and withdrawn on the fourth day of a hospital admission?
a. The child is protesting her separation from her caregivers.
b. The child has adjusted to the hospitalization.
c. The child is experiencing the despair stage of separation.
d. The child has reached the stage of detachment.

 

 

ANS:   C

 

  Feedback
A In the protest stage, the child would be agitated, crying, resistant to caregivers, and inconsolable.
B Toddlers do not readily “adjust” to hospitalization and separation from caregivers.
C In the despair stage of separation, the child exhibits signs of hopelessness and becomes quiet, withdrawn, and apathetic.
D The detachment stage occurs after prolonged separation. During this phase, the child becomes interested in the environment and begins to play.

 

 

DIF:    Cognitive Level: Comprehension       REF:    Text Reference: pg 289

OBJ:    Nursing Process Step: Implementation

MSC:   NCLEX: Psychosocial Integrity

 

  1. A 3-year-old child cries, kicks, and clings to the father when the parents try to leave the hospital room. What is the nurse’s best response to the parents about this behavior?
a. “Your child is showing a normal response to the stress of hospitalization.”
b. “Your child is not coping effectively with hospitalization. We’ll need to get a psychologic consult from the doctor.”
c. “It is helpful for parents to stay with children during hospitalization.”
d. “You can avoid this if you wait to leave after your child falls asleep.”

 

 

ANS:   A

 

  Feedback
A The child is exhibiting a healthy attachment to the father.
B The child’s behavior represents the protest stage of separation and does not represent maladaptive behavior.
C This response places undue stress and guilt on the parents.
D This response fosters the child’s mistrust.

 

 

DIF:    Cognitive Level: Application             REF:    Text Reference: pg 289

OBJ:    Nursing Process Step: Implementation

MSC:   NCLEX: Psychosocial Integrity

 

  1. The hospitalized preschooler fears mutilation and misunderstands illness. Which of the following is the best rationale for this?
a. The child has a fear that mutilation will lead to death.
b. The toddler’s imagination is very active, and he may believe the illness is a result of something he did.
c. The child has a general understanding of body integrity at this age.
d. The child will not have fear related to an IV catheter initiation but will have fear of an impending surgery.

 

 

ANS:   B

 

  Feedback
A Preschoolers do not have the cognitive ability to connect mutilation to death.
B The child has imaginative thoughts at this stage of growth and development. The child may believe that an illness occurred as a result of some personal deed or thought or perhaps because he touched something or someone.
C Preschoolers do not have a sound understanding of body integrity.
D The preschooler fears all types of intrusive procedures whether undergoing a simple procedure such as an IV start or something more invasive such as surgery.

 

 

DIF:    Cognitive Level: Knowledge             REF:    Text Reference: pg 290

OBJ:    Nursing Process Step: Evaluation

MSC:   NCLEX: Health Promotion and Maintenance

 

  1. Which is the most developmentally appropriate intervention when working with the hospitalized adolescent?
a. Encourage peers to call and visit when the adolescent’s condition allows.
b. Be sure the adolescent wears a hospital gown or pajamas throughout the hospitalization.
c. Discourage questions and concerns about the effects of the illness on the adolescent’s appearance.
d. Ask the parents how the adolescent usually copes in new situations.

 

 

ANS:   A

 

  Feedback
A The peer group is important to the adolescent’s sense of belonging and identity; therefore separation from friends is a major source of anxiety for the hospitalized adolescent.
B Adolescents should be encouraged to wear their own clothes to foster their sense of identity.
C Questions and concerns about the adolescent’s appearance and the effects of illness on appearance should be encouraged.
D How the adolescent copes should be asked directly of the adolescent.

 

 

DIF:    Cognitive Level: Application             REF:    Text Reference: pg 292

OBJ:    Nursing Process Step: Implementation

MSC:   NCLEX: Psychosocial Integrity

 

  1. The nurse is discussing toddler development with the mother of a -year-old child. Which statements by the mother indicate she has an understanding of how to help the child succeed in a developmental task?
a. “I always help my daughter complete tasks to help her achieve a sense of accomplishment.”
b. “I provide many opportunities for my daughter to play with other children her age.”
c. “I consistently stress the difference between right and wrong to my daughter.”
d. “I encourage my daughter to do things for herself when she can.”

 

 

ANS:   D

 

  Feedback
A Toddlers should be encouraged to do what they can for themselves.
B Toddlers participate in parallel play. They play next to rather than with age mates.
C Excessive stress on the differences between right and wrong can stifle autonomy in the toddler and foster shame and doubt.
D The toddler’s developmental task is to achieve autonomy. Encouraging toddlers to do things for themselves assists with this developmental task.

 

 

DIF:    Cognitive Level: Comprehension       REF:    Text Reference: pg 290

OBJ:    Nursing Process Step: Evaluation

MSC:   NCLEX: Health Promotion and Maintenance

 

  1. Which of the following interventions would help a hospitalized toddler feel a sense of control?
a. Assign the same nurses to care for the child.
b. Put a cover over the child’s crib.
c. Require parents to stay with the child.
d. Follow the child’s usual routines for feeding and bedtime.

 

 

ANS:   D

 

  Feedback
A Providing consistent caregivers is most applicable for the very young child, such as the neonate and infant.
B Placing a cover over the child’s crib may increase feelings of loss of control.
C Parents are encouraged, rather than expected, to stay with the child during hospitalization.
D Familiar rituals and routines are important to toddlers and give the child a sense of control. Following the child’s usual routines during hospitalization minimizes feelings of loss of control.

 

 

DIF:    Cognitive Level: Comprehension       REF:    Text Reference: pg 290

OBJ:    Nursing Process Step: Implementation

MSC:   NCLEX: Psychosocial Integrity

 

  1. Why is observation for 24 hours in an acute-care setting often appropriate for children?
a. Longer hospital stays are more costly.
b. Children become ill quickly and recover quickly.
c. Children feel less separation anxiety when hospitalized for 24 hours.
d. Families experience less disruption during short hospital stays.

 

 

ANS:   B

 

  Feedback
A A child’s state of wellness, rather than cost, determines the length of stay.
B Children become ill quickly and recover quickly; therefore, they can require acute care for a shorter period of time.
C Separation anxiety is primarily a factor of the stage of development not the length of hospital stay.
D Family disruption is a secondary outcome of a child’s hospitalization; it does not determine length of stay.

 

 

DIF:    Cognitive Level: Comprehension       REF:    Text Reference: pg 285

OBJ:    Nursing Process Step: N/A                MSC:   NCLEX: Physiological Integrity

 

  1. The nurse is aware that separation is the major stressor for which age group?
a. Newborns and infants
b. Infants and toddlers
c. Toddlers and preschoolers
d. Preschoolers and school-age children

 

 

ANS:   B

 

  Feedback
A Newborns feel little separation anxiety as long as their comfort needs are met.
B Separation anxiety is at its peak during the infant and toddler ages.
C Preschoolers are most fearful of injury and pain.
D Loss of control is the primary stressor for school-age children.

 

 

DIF:    Cognitive Level: Knowledge             REF:    Text Reference: pg 289

OBJ:    Nursing Process Step: Assessment     MSC:   NCLEX: Psychosocial Integrity

 

  1. In which age group does the child’s active imagination during unfamiliar experiences increase the stress of hospitalization?
a. Toddlers
b. Preschoolers
c. School-age children
d. Adolescents

 

 

ANS:   B

 

  Feedback
A A toddler’s primary response to hospitalization is separation anxiety.
B Active imagination is a primary characteristic of preschoolers.
C School-age children experience stress with loss of control.
D Adolescents experience stress from separation from their peers.

 

 

DIF:    Cognitive Level: Knowledge             REF:    Text Reference: pg 290

OBJ:    Nursing Process Step: Planning

MSC:   NCLEX: Health Promotion and Maintenance

 

  1. What are the stages of separation experienced by young children when they are hospitalized?
a. Crying, hopelessness, and withdrawal
b. Protest, apathy, and re-entry
c. Protest, despair, and detachment
d. Fear, hopelessness, and detachment

 

 

ANS:   C

 

  Feedback
A Crying, hopelessness, and withdrawal are symptoms of separation.
B Apathy and re-entry are not stages of separation.
C The correct sequence for the stages of separation is protest, despair, and detachment.
D Fear and hopelessness can be felt by the hospitalized child, but they are not stages of separation.

 

 

DIF:    Cognitive Level: Knowledge             REF:    Text Reference: pg 289

OBJ:    Nursing Process Step: N/A                MSC:   NCLEX: Psychosocial Integrity

 

  1. Having explanations for all procedures and selecting their own meals from hospital menus is an important coping mechanism for which of the following age groups?
a. Toddlers
b. Preschoolers
c. School-age children
d. Adolescents

 

 

ANS:   C

 

  Feedback
A Toddlers need routine and parent involvement for coping.
B Preschoolers need simple explanations of procedures.
C School-age children are developmentally ready to accept detailed explanations. School-aged children can select their own menus and become actively involved in other areas of their care.
D Detailed explanations and support of peers help adolescents cope.

 

 

DIF:    Cognitive Level: Application             REF:    Text Reference: pg 291

OBJ:    Nursing Process Step: Implementation

MSC:   NCLEX: Psychosocial Integrity

 

  1. What is the best action for the nurse to take when a 5-year-old child who requires another 2 days of IV antibiotics, cries, screams, and resists having his IV restarted?
a. Exit the room and leave the child alone until he stops crying.
b. Tell the child big boys and girls “don’t cry.”
c. Let the child decide which color arm board to use with his IV.
d. Proceed quickly with the IV antibiotics to decrease stress.

 

 

ANS:   C

 

  Feedback
A Leaving the child alone robs the child of support when a coping difficulty exists.
B Crying is a normal response to stress.
C Giving the preschooler some choice and control, while maintaining boundaries of treatment, supports the child’s coping skills.
D The child needs time to adjust and support to cope with unfamiliar and painful procedures during hospitalization.

 

 

DIF:    Cognitive Level: Application             REF:    Text Reference: pg 290

OBJ:    Nursing Process Step: Implementation

MSC:   NCLEX: Psychosocial Integrity

 

  1. What is the best nursing response to the mother of a 4-year-old child who asks what she can do to help the child cope with a sibling’s repeated hospitalizations?
a. Recommend that the child be sent to visit the grandmother until the sibling returns home.
b. Inform the parent that the child is too young to visit the hospital.
c. Assume the child understands that the sibling will soon be discharged because the child asks no questions.
d. Help the mother give the child a simple explanation of the treatment and encourage the mother to have the child visit the hospitalized sibling.

 

 

ANS:   D

 

  Feedback
A Separation from family and home may intensify fear and anxiety.
B Parents are experts on their children and need to determine when their child can visit a hospital.
C Children may have difficulty expressing questions and fears and need the support of parents and other caregivers.
D Needs of a sibling will be better met with factual information and contact with the ill child.

 

 

DIF:    Cognitive Level: Application             REF:    Text Reference: pg 302

OBJ:    Nursing Process Step: Implementation

MSC:   NCLEX: Psychosocial Integrity

 

  1. How would the nurse advise parents whose preschooler used to sleep through the night and now awakens at intervals after a short hospitalization?
a. Regressive behavior after a hospitalization is normal and usually short term.
b. The child is probably expressing anger.
c. Egocentric behavior often manifests itself when the child is left alone to sleep.
d. The child is probably feeling pain and needs further evaluation.

 

 

ANS:   A

 

  Feedback
A Regression is manifested in a variety of ways, is normal, and usually is short term.
B Nighttime waking is not associated with anger.
C Egocentric behavior is not an explanation for nighttime waking.
D More information is needed before assessment of pain can be made.

 

 

DIF:    Cognitive Level: Comprehension       REF:    Text Reference: pg 295

OBJ:    Nursing Process Step: Implementation

MSC:   NCLEX: Physiological Integrity

 

  1. Which of the following is an appropriate nursing intervention for the hospitalized neonate?
a. Assign the neonate to a room with other neonates.
b. Provide play activities in the hospital room.
c. Offer the neonate a pacifier between feedings.
d. Request that parents bring security object from home.

 

 

ANS:   C

 

  Feedback
A The neonate is not aware of other children. The choice of roommate will not affect the neonate socially. It is important for older children to room with similar-age children.
B Formal play activities would not be relevant for the neonate.
C The neonate needs opportunities for nonnutritive sucking and oral stimulation with a pacifier.
D Having parents bring a security object from home is applicable to older children.

 

 

DIF:    Cognitive Level: Comprehension       REF:    Text Reference: pg 294

OBJ:    Nursing Process Step: Implementation

MSC:   NCLEX: Physiological Integrity

 

  1. Which approach will best help a 7-year-old child cope with a lengthy course of intravenous antibiotic therapy?
a. Arrange for the child to go to the playroom daily.
b. Ask the child to draw you a picture about himself.
c. Allow the child to participate in injection play.
d. Give the child stickers for cooperative behavior.

 

 

ANS:   C

 

  Feedback
A The hospitalized child should have opportunities to go to the playroom each day if his condition warrants. This free play does not have any specific therapeutic purpose.
B Children can express their thoughts and beliefs through drawing. Asking the child to draw a picture of himself may not elicit the child’s feelings about his treatment.
C Injection play is an appropriate intervention for the child who has to undergo frequent blood work, injections, intravenous therapy, or any other therapy involving syringes and needles.
D Rewards such as stickers may enhance cooperative behavior. They will not address coping with painful treatments.

 

 

DIF:    Cognitive Level: Application             REF:    Text Reference: pg 295

OBJ:    Nursing Process Step: Implementation

MSC:   NCLEX: Psychosocial Integrity

 

  1. A 6-year-old child tells the nurse that she does not like the food at the hospital. A review of intake reveals she has eaten very little for the past 2 days. Which of the following is an appropriate intervention for the nursing diagnosis: Imbalanced Nutrition: Less than body requirements?
a. Select nutritious foods on the menu for the child.
b. Permit the child to eat junk foods at snack times.
c. Arrange the child’s meal tray with generous portions of food.
d. Encourage family members to bring foods from home.

 

 

ANS:   D

 

  Feedback
A A 6-year-old child should be permitted to make her own menu selections with the assistance of an adult as needed. Allowing the child to select foods gives the child control and provides an opportunity to select foods that the child likes.
B Junk foods have little or no nutritional value. If the child is permitted to eat junk food, she may refuse to eat nutritious food at mealtimes.
C Meals served to children should have small portions. Children may feel overwhelmed by large portions and refuse to eat any of the food.
D Having the parents bring foods that the child likes and is familiar with will increase the likelihood that she will eat.

 

 

DIF:    Cognitive Level: Application             REF:    Text Reference: pg 298

OBJ:    Nursing Process Step: Planning         MSC:   NCLEX: Physiological Integrity

 

  1. A -year-old child who is toilet trained has had several “accidents” since hospital admission. What is the nurse’s best action in this situation?
a. Find out how long the child has been toilet trained at home.
b. Tell the parent it is necessary to begin toilet training again.
c. Explain how to use a bedpan and place it close to the child.
d. Follow home routines of elimination.

 

 

ANS:   D

 

  Feedback
A Some regression to previous behaviors is normal during hospitalization, even when the child has been practicing the skill for some time.
B Hospitalization is a stressful experience and is not an appropriate time to learn or relearn a skill.
C Developmentally, the -year-old child cannot use a bedpan independently.
D Cooperation will increase and anxiety will decrease if the child’s normal routine and rituals are maintained.

 

 

DIF:    Cognitive Level: Application             REF:    Text Reference: pgs 298-299

OBJ:    Nursing Process Step: Implementation

MSC:   NCLEX: Psychosocial Integrity

 

  1. Which question would most likely elicit information about how a family is coping with a child’s hospitalization?
a. “Was this admission an emergency?”
b. “How has your child’s hospitalization affected your family?”
c. “Who is taking care of your other children while you are here?”
d. “Is this the child’s first hospitalization?”

 

 

ANS:   B

 

  Feedback
A This is a closed-ended question. The nurse would have to ask other questions to gather additional information.
B Open-ended questions encourage communication. Ensuring a positive outcome from the hospital experience can be optimized by the nurse addressing the health needs of family members as well as the needs of the child.
C This is a closed-ended question. The parent answers the question with a short response. The nurse must ask additional questions to learn more about the family.
D The parent would answer “yes” or “no” to this question and expect the conversation to be over. The nurse must ask additional questions to learn more about the family.

 

 

DIF:    Cognitive Level: Comprehension       REF:    Text Reference: pgs 301-302

OBJ:    Nursing Process Step: Assessment     MSC:   NCLEX: Psychosocial Integrity

 

  1. What would the nurse advise the mother of a 4-year-old child to bring with her child to the outpatient surgery center on the day of surgery?
a. Snacks
b. Fruit juice boxes
c. All of the child’s medications
d. One of the child’s favorite toys

 

 

ANS:   D

 

  Feedback
A The child will be NPO before surgery; therefore, including snacks for the child is contraindicated.
B The child will be NPO before surgery. Unnecessary stress will result when the child is denied the juice.
C It is not necessary to bring all medications on the day of surgery. The medication the child has been receiving should have been noted during the preoperative workup. The parent should be knowledgeable of which medications the child has been taking if further information is necessary.
D A familiar toy can be effective in decreasing a child’s stress in an unfamiliar environment.

 

 

DIF:    Cognitive Level: Application             REF:    Text Reference: pg 295

OBJ:    Nursing Process Step: Implementation

MSC:   NCLEX: Health Promotion and Maintenance