Chapter 32: The Toddler and Family: Chapter 33: The Preschooler and Family: Chapter 34: The School-Age Child and Family:

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Chapter 32: The Toddler and Family: Chapter 33: The Preschooler and Family: Chapter 34: The School-Age Child and Family: Chapter 35: The Adolescent and Family: Chapter 36: Chronic Illness, Disability... , and End-of-Life Care Chapter 32: The Toddler and Family 1. Which factor is most important in predisposing toddlers to frequent infections such as otitis media, tonsillitis, and upper respiratory tract infections? a. Respirations are abdominal. b. Pulse and respiratory rates are slower than those in infancy. c. Defense mechanisms are less efficient than those during infancy. d. Short, straight internal ear/throat structures and large tonsil/adenoid lymph tissue are present. 2. The psychosocial developmental tasks of toddlerhood include: a. Development of a conscience. b. Recognition of sex differences. c. Ability to get along with age mates. d. Ability to withstand delayed gratification. 3. 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 nurse’s best interpretation of this behavior is that: 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. 4. The nurse is planning care for a 17-month-old child. According to Piaget, in what stage would the nurse expect the child to be? a. Trust c. Secondary circular reaction b. Preoperations d. Tertiary circular reaction 5. What describes a toddler’s cognitive development at age 20 months? a. Searches for an object only if he or she sees it being hidden b. Realizes that “out of sight” is not out of reach c. Puts objects into a container but cannot take them out d. Understands the passage of time such as “just a minute” and “in an hour” 6. Although a 14-month-old girl received a shock from an electrical outlet recently, her parents find her about to place a paper clip in another outlet. The best interpretation of this behavior is that: 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. 7. Two toddlers are playing in a sandbox when one child suddenly grabs a toy from the other child. The best interpretation of this behavior is that: a. This is typical behavior because toddlers are aggressive. b. This is typical behavior because toddlers are egocentric. c. Toddlers should know that sharing toys is expected of them. d. Toddlers should have the cognitive ability to know right from wrong. 8. Which statement about toilet training is correct? 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. 9. Which characteristic best describes the gross motor skills of a 24-month-old child? a. Skips c. Broad jumps b. Rides tricycle d. Walks up and down stairs 10. In the clinic waiting room, a nurse observes a parent showing an 18-month-old child how to make a tower out of blocks. In this situation the nurse should recognize that: a. Blocks at this age are used primarily for throwing. b. Toddlers are too young to imitate the behavior of others. c. Toddlers are capable of building a tower of blocks. d. Toddlers are too young to build a tower of blocks. 11. 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 nurse’s best reply is: a. “Let’s see if we can figure out why he hates the new baby.” b. “That’s a strong statement to come from such a small boy.” c. “Let’s refer him to counseling to work this hatred out. It’s not a normal response.” d. “That is a normal response to the birth of a sibling. Let’s look at ways to deal with this.” 12. A toddler’s parent asks the nurse for suggestions on dealing with temper tantrums. The most appropriate recommendation is to: a. Punish the child. b. Leave the child alone until the tantrum is over. c. Ignore the behavior, provided that it is not injurious. d. Explain to child that this is wrong. 13. A parent asks the nurse about how to respond to negativism in toddlers. The most appropriate recommendation is to: a. Punish the child. b. Provide more attention. c. Ask child not always to say “no.” d. Reduce the opportunities for a “no” answer. 14. The parents of a 2-year-old tell the nurse that they are concerned because the toddler has started to use “baby talk” since the arrival of their new baby. The nurse should recommend that the parents: a. Ignore the “baby talk.” b. Explain to the toddler that “baby talk” is for babies. c. Tell the toddler frequently, “You are a big kid now.” d. Encourage the toddler to practice more advanced patterns of speech. 15. Parents tell the nurse that their toddler daughter eats little at mealtimes, only sits at the table with the family briefly, and wants snacks “all the time.” The nurse should recommend that the parents: a. Give her planned, frequent, and 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. 16. 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: a. A sign that the child is spoiled. c. Regression, common at this age. b. A way to exert unhealthy control. d. Ritualism, common at this age. 17. Developmentally, most children at age 12 months: a. Use a spoon adeptly. b. Relinquish the bottle voluntarily. c. Eat the same food as the rest of the family. d. Reject all solid food in preference to the bottle. 18. The most effective way to clean a toddler’s teeth is for the: a. Child to brush regularly with toothpaste of his or her choice. b. Parent to stabilize the chin with one hand and brush with the other. c. Parent to brush the mandibular occlusive surfaces, leaving the rest for the child. d. Parent to brush the front labial surfaces, leaving the rest for the child. 19. The nurse is discussing with a parent group the importance of fluoride for healthy teeth. The nurse should recommend that the parents: a. Use fluoridated mouth rinses in children older than 1 year. b. Have children brush teeth with fluoridated toothpaste unless fluoride content of water supply is adequate. c. Give fluoride supplements to breastfed infants beginning at age 1 month. d. Determine whether water supply is fluoridated. 20. An appropriate recommendation in preventing tooth decay in young children is to: a. Substitute raisins for candy. b. Serve sweets after a meal. c. Use honey or molasses instead of refined sugar. d. Serve sweets between meals. 21. The leading cause of death during the toddler period is: a. Injuries. c. Congenital disorders. b. Infectious diseases. d. Childhood diseases. 22. The nurse recommends to parents that peanuts are not a good snack food for toddlers. The nurse’s rationale for this action is that: a. They are low in nutritive value. c. They cannot be entirely digested. b. They are very high in sodium. d. They can be easily aspirated. 23. The parent of 16-month-old Chris asks, “What is the best way to keep Chris from getting into our medicines at home?” The nurse should advise that: a. “All medicines should be locked securely away.” b. “The medicines should be placed in high cabinets.” c. “Chris just needs to be taught not to touch medicines.” d. “Medicines should not be kept in the homes of small children.” 24. The most fatal type of burn in the toddler age-group is: a. Flame burn from playing with matches. b. Scald burn from high-temperature tap water. c. Hot object burn from cigarettes or irons. d. Electric burn from electrical outlets. 25. 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.” 26. Which toy is the most developmentally appropriate for an 18- to 24-month-old child? a. A push-pull toy c. A bicycle with training wheels b. Nesting blocks d. A computer 27. 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. 28. Which comments indicate 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.” 29. What is helpful to tell a mother who is concerned about preventing sleep problems in her 2-year-old 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 caregiver about eliminating the afternoon nap. d. Use a night-light in the child’s room. 30. Steven, 16 months old, 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 c. Irreversibility b. Ritualism d. Delayed cognitive development 31. Which should the nurse expect for a toddler’s language development at age 18 months? a. Vocabulary of 25 words b. Increasing level of comprehension c. Use of phrases d. Approximately one third of speech understandable 32. Kimberly’s parents have been using a rearward-facing, convertible car seat since she was born. The parents should be taught that most car seats can be safely switched to the forward-facing position when the child reaches which age? a. 1 year c. 3 years b. 2 years d. 4 years 33. Which play item should the nurse bring from the playroom to a hospitalized toddler in isolation? a. Small plastic Legos c. Brightly colored balloon b. Set of large plastic building blocks d. Coloring book and crayons 34. A nurse places some x-ray contrast the toddler is to drink in a small cup instead of a large cup. Which concept of a toddler’s preoperational thinking is the nurse using? a. Inability to conserve c. Centration b. Magical thinking d. Irreversibility 35. Parents need further teaching about the use of car safety seats if they make which statement? a. “Even if our toddler helps buckle the straps, we will double-check the fastenings.” b. “We won’t start the car until everyone is properly restrained.” c. “We won’t need to use the car seat on short trips to the store.” d. “We will anchor the car seat to the car’s anchoring system.” 36. Which are characteristic of the physical development of a 30-month-old child (select all that apply)? a. Birth weight has doubled. b. Primary dentition is complete. c. Sphincter control is achieved. d. Anterior fontanel is open. e. Length from birth is doubled. , C 37. Motor vehicle injuries are a significant threat to young children. Knowing this, the nurse plans a teaching session with a toddler’s parents on car safety. Which will she teach (select all that apply)? a. Secure in a rear-facing, upright, car safety seat. b. Place the car safety seat in the rear seat, behind the driver’s seat. c. Harness safety straps should be fit snugly. d. Place the car safety seat in the front passenger seat equipped with an air bag. e. After the age of 2 years, toddlers can be placed in a forward-facing car seat. , C, E 38. The nurse is assessing parental knowledge of temper tantrums. Which are true statements regarding temper tantrums (select all that apply)? a. Temper tantrums are a common response to anger and frustration in toddlers. b. Temper tantrums often include screaming, kicking, throwing things, and head banging. c. Parents can effectively manage temper tantrums by giving in to the child’s demands. d. Children having temper tantrums should be safely isolated and ignored. e. Parents can learn to anticipate times when tantrums are more likely to occur. , B, D, E 39. A nurse is planning care for a hospitalized toddler in the preoperational thinking stage. Which characteristics should the nurse expect in this stage (select all that apply)? a. Concrete thinking b. Egocentrism c. Animism d. Magical thinking e. Ability to reason , C, D 40. Which should the nurse teach to parents of toddlers about accidental poison prevention (select all that apply)? a. Keep toxic substances in the garage. b. Discard empty poison containers. c. Know the number of the nearest poison control center. d. Remove colorful labels from containers of toxic substances. e. Caution child against eating nonedible items, such as plants. , C, E 41. Which gross motor milestones should the nurse assess in an 18-month-old child (select all that apply)? a. Jumps in place with both feet b. Takes a few steps on tiptoe c. Throws ball overhand without falling d. Pulls and pushes toys e. Stands on one foot momentarily , C, D Chapter 33: The Preschooler and Family 1. Which accomplishment would the nurse expect of a healthy 3-year-old child? a. Jump rope b. Ride a two-wheel bicycle c. Skip on alternate feet d. Balance on one foot for a few seconds 2. In terms of fine motor development, what could the 3-year-old child be expected to do? a. Tie shoelaces. b. Use scissors or a pencil very well. c. Draw a person with seven to nine parts. d. Copy (draw) a circle. 3. In terms of cognitive development, the 5-year-old child would be expected to: a. Use magical thinking. b. Think abstractly. c. Understand conservation of matter. d. Be able to comprehend another person’s perspective. 4. What is descriptive of the preschooler’s understanding of time? a. Has no understanding of time b. Associates time with events c. Can tell time on a clock d. Uses terms like “yesterday” appropriately 5. The nurse is caring for a hospitalized 4-year-old boy, Ryan. His parents tell the nurse that they will be back to visit at 6 PM. When Ryan asks the nurse when his parents are coming, the nurse’s best response is: a. “They will be here soon.” b. “They will come after dinner.” c. “Let me show you on the clock when 6 PM is.” d. “I will tell you every time I see you how much longer it will be.” 6. A 4-year-old boy is hospitalized with a serious bacterial infection. He tells the nurse that he is sick because he was “bad.” The nurse’s best interpretation of this comment is that it is: a. A sign of stress. b. Common at this age. c. Suggestive of maladaptation. d. Suggestive of excessive discipline at home. 7. In terms of language and cognitive development, a 4-year-old child would be expected to: a. Think in abstract terms. b. Follow simple commands. c. Understand conservation of matter. d. Comprehend another person’s perspective. 8. Which type of play is most typical of the preschool period? a. Solitary c. Associative b. Parallel d. Team 9. Imaginary playmates are beneficial to the preschool child because they: a. Take the place of social interactions. b. Take the place of pets and other toys. c. Become friends in times of loneliness. d. Accomplish what the child has already successfully accomplished. 10. Which characteristic best describes the language of a 3-year-old child? a. Asks meanings of words b. Follows directional commands c. Can describe an object according to its composition d. Talks incessantly, regardless of whether anyone is listening 11. By what age would the nurse expect that most children could understand prepositional phrases such as “under,” “on top of,” “beside,” and “in back of”? a. 18 months c. 3 years b. 24 months d. 4 years 12. A useful skill that the nurse should expect a 5-year-old child to be able to master is to: a. Tie shoelaces. c. Hammer a nail. b. Use a knife to cut meat. d. Make change from a quarter. 13. The nurse is guiding parents in selecting a day care facility for their child. When making the selection, it is especially important to consider: a. Structured learning environment. b. Socioeconomic status of children. c. Cultural similarities of children. d. Teachers knowledgeable about development. 14. The parent of a 4-year-old son tells the nurse that the child believes “monsters and the boogeyman” are in his bedroom at night. The nurse’s best suggestion for coping with this problem is to: a. Insist that the child sleep with his parents until the fearful phase passes. b. Suggest involving the child to find a practical solution such as a night-light. c. Help the child understand that these fears are illogical. d. Tell the child frequently that monsters and the boogeyman do not exist. 15. Preschoolers’ fears can best be dealt with by which intervention? a. Actively involving them in finding practical methods to deal with the frightening experience b. Forcing them to confront the frightening object or experience in the presence of their parents c. Using logical persuasion to explain away their fears and help them recognize how unrealistic the fears are d. Ridiculing their fears so they understand that there is no need to be afraid 16. A normal characteristic of the language development of a preschool-age child is: a. Lisp. c. Echolalia. b. Stammering. d. Repetition without meaning. 17. During the preschool period, the emphasis of injury prevention should be placed on: a. Constant vigilance and protection. b. Punishment for unsafe behaviors. c. Education for safety and potential hazards. d. Limitation of physical activities. 18. Acyclovir (Zovirax) is given to children with chickenpox to: a. Minimize scarring. c. Prevent aplastic anemia. b. Decrease the number of lesions. d. Prevent spread of the disease. 19. Which medication may be given to high risk children after exposure to chickenpox to prevent varicella? a. Acyclovir b. Vitamin A c. Diphenhydramine hydrochloride d. Varicella zoster immune globulin (VZIG) 20. Vitamin A supplementation may be recommended for the young child who has: a. Mumps. c. Measles (rubeola). b. Rubella. d. Erythema infectiosum. 21. When is a child with chickenpox considered to be no longer contagious? a. When fever is absent c. 24 hours after lesions erupt b. When lesions are crusted d. 8 days after onset of illness 22. The nurse is performing an assessment on a child and notes the presence of Koplik’s spots. In which communicable disease are Koplik’s spots present? a. Rubella c. Chickenpox (varicella) b. Measles (rubeola) d. Exanthema subitum (roseola) 23. Which statement best describes a child who is abused by the parent(s)? a. Unintentionally contributes to the abusing situation b. Belongs to a low socioeconomic population c. Is healthier than the nonabused siblings d. Abuses siblings in the same way as child is abused by the parent(s) 24. A common characteristic of those who sexually abuse children is that they: a. Pressure the victim into secrecy. b. Are usually unemployed and unmarried. c. Are unknown to victims and victims’ families. d. Have many victims that are each abused only once. 25. Which statement, made by a 4-year-old child’s father, is true about the care of the preschooler’s teeth? a. “Because the ‘baby teeth’ are not permanent, they are not important to the child.” b. “My son can be encouraged to brush his teeth after I have thoroughly cleaned his teeth.” c. “My son’s ‘permanent teeth’ will begin to come in at 4 to 5 years of age.” d. “Fluoride supplements can be discontinued when my son’s ‘permanent teeth’ erupt.” 26. In providing anticipatory guidance to parents whose child will soon be entering kindergarten, which 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 27. A 4-year-old child tells the nurse that she does not want another blood sample drawn because “I need all my insides, and I don’t want anyone taking them out.” Which is the nurse’s best interpretation of this? a. Child is being overly dramatic. b. Child has a disturbed body image. c. Preschoolers have poorly defined body boundaries. d. Preschoolers normally have a good understanding of their bodies. 28. Parents tell the nurse that they found their 3-year-old daughter and a male cousin of the same age inspecting each other closely as they used the bathroom. Which is the most appropriate recommendation the nurse should make? a. Punish children so this behavior stops. b. Neither condone nor condemn the curiosity. c. Allow children unrestricted permission to satisfy this curiosity. d. Get counseling for this unusual and dangerous behavior. 29. Which common childhood communicable disease may cause severe defects in the fetus when it occurs in its congenital form? a. Erythema infectiosum c. Rubeola b. Roseola d. Rubella 30. Which is the causative agent of scarlet fever? a. Enteroviruses b. Corynebacterium organisms c. Scarlet fever virus d. Group A -hemolytic streptococci (GABHS) 31. Which is probably the most important criterion on which to base the decision to report suspected child abuse? a. Inappropriate parental concern for the degree of injury b. Absence of parents for questioning about child’s injuries c. Inappropriate response of child d. Incompatibility between the history and injury observed 32. 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 e. Associative play , B, C, E 33. Strict isolation is required for a child who is hospitalized with (select all that apply): a. Mumps. b. Chickenpox. c. Exanthema subitum (roseola). d. Erythema infectiosum (fifth disease). e. Parvovirus B19. , B, C, D 34. In terms of language and cognitive development, a 4-year-old child would be expected to have which traits (select all that apply)? a. Think in abstract terms. b. Follow directional commands. c. Understand conservation of matter. d. Use sentences of eight words. e. Tell exaggerated stories. , E 35. Which toys should a nurse provide to promote imaginative play for a 3-year-old hospitalized child (select all that apply)? a. Plastic telephone b. Hand puppets c. Jigsaw puzzle (100 pieces) d. Farm animals and equipment e. Jump rope , B, D Chapter 34: The School-Age Child and Family 1. Which statement accurately describes physical development during the school-age years? a. The child’s weight almost triples. b. A child grows an average of 2 inches per year. c. Few physical differences are apparent among children at the end of middle childhood. d. Fat gradually increases, which contributes to the child’s heavier appearance. 2. Generally the earliest age at which puberty begins is: a. 13 years in girls, 13 years in boys. c. 10 years in girls, 12 years in boys. b. 11 years in girls, 11 years in boys. d. 12 years in girls, 10 years in boys. 3. What describes the cognitive abilities of school-age children? a. Have developed the ability to reason abstractly b. Become capable of scientific reasoning and formal logic c. Progress from making judgments based on what they reason to making judgments based on what they see d. Have the ability to classify, group and sort, and hold a concept in their minds while making decisions based on that concept 4. What describes moral development in younger school-age children? a. The standards of behavior now come from within themselves. b. They do not yet experience a sense of guilt when they misbehave. c. They know the rules and behaviors expected of them but do not understand the reasons behind them. d. They no longer interpret accidents and misfortunes as punishment for misdeeds. 5. Which statement characterizes moral development in older school-age children? a. They are able to judge an act by the intentions that prompted it rather than just by the consequences. b. Rules and judgments become more absolute and authoritarian. c. They view rule violations in an isolated context. d. They know the rules but cannot understand the reasons behind them. 6. An 8-year-old girl tells the nurse that she has cancer because God is punishing her for “being bad.” She shares her concern that, if she dies, she will go to hell. The nurse should interpret this as being: a. A belief common at this age. b. A belief that forms the basis for most religions. c. Suggestive of excessive family pressure. d. Suggestive of a failure to develop a conscience. 7. The role of the peer group in the life of school-age children is that it: a. Gives them an opportunity to learn dominance and hostility. b. Allows them to remain dependent on their parents for a longer time. c. Decreases their need to learn appropriate sex roles. d. Provides them with security as they gain independence from their parents. 8. A group of boys ages 9 and 10 years have formed a “boys-only” club that is open to neighborhood and school friends who have skateboards. This should be interpreted as: a. Behavior that encourages bullying and sexism. b. Behavior that reinforces poor peer relationships. c. Characteristic of social development of this age. d. Characteristic of children who later are at risk for membership in gangs. 9. What is descriptive of the play of school-age children? a. Individuality in play is better tolerated than at earlier ages. b. Knowing the rules of a game gives an important sense of belonging. c. They like to invent games, making up the rules as they go. d. Team play helps children learn the universal importance of competition and winning. 10. What is characteristic of dishonest behavior in children ages 8 to 10 years? a. Cheating during games is now more common. b. Lying results from the inability to distinguish between fact and fantasy. c. They may steal because their sense of property rights is limited. d. They may lie to meet expectations set by others that they have been unable to attain. 11. A 9-year-old girl often comes to the school nurse complaining of stomach pains. Her teacher says that she is completing her schoolwork satisfactorily, but lately she has been somewhat aggressive and stubborn in the classroom. The school nurse should recognize this as: a. Signs of stress. b. Developmental delay. c. A physical problem causing emotional stress. d. Lack of adjustment to the school environment. 12. Which statement best describes fear in school-age children? a. They are increasingly fearful for body safety. b. Most of the new fears that trouble them are related to school and family. c. They should be encouraged to hide their fears to prevent ridicule by peers. d. Those who have numerous fears need continuous protective behavior by parents to eliminate these fears. 13. The father of 12-year-old Ryan tells the nurse that he is concerned about his son getting “fat.” Ryan’s body mass index for age is at the 60th percentile. The most appropriate nursing action is to: a. Reassure the father that Ryan is not “fat.” b. Reassure the father that Ryan is just a growing child. c. Suggest a low-calorie, low-fat diet. d. Explain that this is typical of the growth pattern of boys at this age. 14. The school nurse has been asked to begin teaching sex education in the 5th grade. The nurse should recognize that: a. Children in 5th grade are too young for sex education. b. Children should be discouraged from asking too many questions. c. Correct terminology should be reserved for children who are older. d. Sex can be presented as a normal part of growth and development. 15. An important consideration for the school nurse who is planning a class on bicycle safety is: a. Most bicycle injuries involve collision with an automobile. b. Head injuries are the major causes of bicycle-related fatalities. c. Children should wear bicycle helmets if they ride on paved streets. d. Children should not ride double unless the bicycle has an extra-large seat. 16. When teaching injury prevention during the school-age years, the nurse should include: a. Teaching the need to fear strangers. b. Teaching basic rules of water safety. c. Avoiding letting children cook in microwave ovens. d. Cautioning children against engaging in competitive sports. 17. Which behavior is not normally demonstrated in the 8-year-old child? a. Understands that his or her point of view is not the only one b. Enjoys telling riddles and silly jokes c. Understands that pouring liquid from a small to a large container does not change the amount d. Engages in fantasy and magical thinking 18. The ability to mentally understand that 1 + 3 = 4 and 4 – 3 = 1 occurs in which stage of cognitive development? a. Concrete operations stage c. Intuitive thought stage b. Formal operations stage d. Preoperations stage 19. Which activity is most appropriate for developing fine motor skills in the school-age child? a. Drawing c. Soccer b. Singing d. Swimming 20. Which comment is most developmentally typical of a 7-year-old boy? 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.” 21. 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. 22. Which behavior 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 23. A nurse is assessing an older school-age child recently admitted to the hospital. Which assessment indicates that the child is in an appropriate stage of cognitive development? 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 24. Teasing can be common during the school-age years. Which of the following does the nurse recognize as applying most to teasing? a. Can have a lasting effect on children b. Is not a significant threat to self-concept c. Is rarely based on anything that is concrete d. Is usually ignored by the child who is being teased 25. A child has an evulsed (knocked-out) tooth. In which medium should the nurse instruct the parents to place the tooth for transport to the dentist? a. Cold milk c. Warm salt water b. Cold water d. A dry, clean jar 26. A nurse is teaching parents of first-grade children general guidelines to assist their children in adapting to school. Which statement by the parents indicates they understand the teaching? a. “We will only meet with the teacher if problems occur.” b. “We will discourage hobbies so our child focuses on schoolwork.” c. “We will plan a trip to the library as often as possible.” d. “We will expect our child to make all As in school.” 27. A school nurse is teaching dental health practices to a group of sixth-grade children. How often should the nurse recommend the children brush their teeth? a. Twice a day b. Three times a day c. After meals d. After meals and snacks, and at bedtime 28. Parents of a 12-year-old child ask the clinic nurse, “How many hours of sleep should our child get?’ The nurse should respond that 12-year-old children need how many hours of sleep at night? a. 8 c. 10 b. 9 d. 11 29. A nurse planning care for a school-age child should take into account that which thought process is seen at this age? a. Animism c. Ability to conserve b. Magical thinking d. Thoughts are all-powerful 30. Which 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 he can be a son, brother, or nephew at the same time. b. The school-age child understands the principles of adding, subtracting, and reversibility. 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 and animism. , B, C 31. Peer victimization is becoming a significant problem for school-age children and adolescents in the United States. Parents should be educated regarding signs that a child is being bullied. These might include (select all that apply): a. The child spends an inordinate amount of time in the nurse’s office. b. Belongings frequently go missing or are damaged. c. The child wants to be driven to school. d. School performance improves. e. The child freely talks about his or her day. , B, C 32. A nurse is planning care for a 7-year-old child hospitalized with osteomyelitis. Which activities should the nurse plan to bring from the playroom for the child (select all that apply)? a. Paper and some paints b. Board games c. Jack-in-the-box d. Stuffed animals e. Computer games , B, E 33. A nurse teaches parents that team play is important for school-age children. Which can children develop by experiencing team play (select all that apply)? a. Achieve personal goals over group goals. b. Learn complex rules. c. Experience competition. d. Learn about division of labor. , C, D 34. A nurse is recommending strategies to a group of school-age children for prevention of obesity. Which should the nurse include (select all that apply)? a. Eat breakfast daily. b. Limit fruits and vegetables. c. Have frequent family meals with parents present. d. Eat frequently at restaurants. e. Limit television viewing to 2 hours a day. , C, E MATCHING Because school-age children have developed increased muscular coordination and can apply cognitive ability to their behavior, the number of injuries in middle childhood is diminished compared to early childhood. Even so, injuries still occur near home and school. The most effective means of prevention is education for both the child and family regarding the hazards of risk-taking and the improper use of equipment. Please match the developmental ability of the school-age child with the injury for which he or she is at risk. a. Motor vehicle accidents d. Poisoning b. Drowning e. Bodily damage c. Burns 35. Is apt to overdo 36. Confidence exceeds physical capacity 37. Is excited by speed and motion 38. Enjoys trying new things 39. May be easily influenced by peers 35. 36. ANS: E 37. 38. 39. Chapter 35: The Adolescent and Family MULTIPLE CHOICE 1. In girls, the initial indication of puberty is: a. Menarche. c. Growth of pubic hair. b. Growth spurt. d. Breast development. 2. The mean age of menarche in the United States is: a. 11.5 years c. 13.5 years b. 12.5 years d. 14 years 3. By what age should concerns about pubertal delay be considered in boys? a. 12 to 12.5 years c. 13 to 13.5 years b. 12.5 to 13 years d. 13.5 to 14 years 4. Steve, 14 years old, mentions that he now has to use deodorant but never had to before. The nurse’s response should be based on knowledge that: a. Eccrine sweat glands in the axillae become fully functional during puberty. b. Sebaceous glands become extremely active during puberty. c. New deposits of fatty tissue insulate the body and cause increased sweat production. d. Apocrine sweat glands reach secretory capacity during puberty. The apocrine sweat glands, nonfunctional in children, reach secretory capacity during puberty. They secrete a thick substance as a result of emotional stimulation that, when acted on by surface bacteria, becomes highly odoriferous. They are limited in distribution and grow in conjunction with hair follicles in the axillae, genital and anal areas, and other areas. Eccrine sweat glands are present almost everywhere on the skin and become fully functional and respond to emotional and thermal stimulation. Sebaceous glands become extremely active at this time, especially those on the genitals and the “flush” areas of the body, such as face, neck, shoulders, upper back, and chest. This increased activity is important in the development of acne. New deposits of fatty tissue insulate the body and cause increased sweat production, but this is not the etiology of apocrine sweat gland activity. PTS: 1 DIF: Cognitive Level: Comprehension REF: 1014 OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance 5. According to Erikson, the psychosocial task of adolescence is developing: a. Intimacy. c. Initiative. b. Identity. d. Independence. Traditional psychosocial theory holds that the developmental crises of adolescence lead to the formation of a sense of identity. Intimacy is the developmental stage for early adulthood. Initiative is the developmental stage for early childhood. Independence is not one of Erikson’s developmental stages. PTS: 1 DIF: Cognitive Level: Comprehension REF: 1014 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 6. According to Piaget, the adolescent is in the fourth stage of cognitive development, or period of: a. Formal operations. c. Conventional thought. b. Concrete operations. d. Postconventional thought. Cognitive thinking culminates with capacity for abstract thinking. This stage, the period of formal operations, is Piaget’s fourth and last stage. The concrete operations stage usually develops between ages 7 and 11 years. Conventional and postconventional thought refer to Kohlberg’s stages of moral development. PTS: 1 DIF: Cognitive Level: Comprehension REF: 1015 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 7. Which aspect of cognition develops during adolescence? a. Capability to use a future time perspective b. Ability to place things in a sensible and logical order c. Ability to see things from the point of view of another d. Progress from making judgments based on what they see to making judgments based on what they reason Adolescents are no longer restricted to the real and actual. They also are concerned with the possible; they think beyond the present. During concrete operations (between ages 7 and 11 years), children exhibit the ability to place things in a sensible and logical order, the ability to see things from another’s point of view, and the ability to make judgments based on what they reason rather than just what they see. PTS: 1 DIF: Cognitive Level: Comprehension REF: 1015 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 8. The parents of a 14-year-old girl express concerns about the number of hours their daughter spends with her friends. The nurse explains that peer relationships become more important during adolescence because: a. Adolescents dislike their parents. b. Adolescents no longer need parental control. c. They provide adolescents with a feeling of belonging. d. They promote a sense of individuality in adolescents. The peer group serves as a strong support to teenagers, providing them with a sense of belonging and strength and power. During adolescence, the parent-child relationship changes from one of protection-dependency to one of mutual affection and quality. Parents continue to play an important role in personal and health-related decisions. The peer group forms the transitional world between dependence and autonomy. PTS: 1 DIF: Cognitive Level: Application REF: 1017 OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance 9. An adolescent boy tells the nurse that he has recently had homosexual feelings. The nurse’s response should be based on knowledge that: a. This indicates that the adolescent is homosexual. b. This indicates that the adolescent will become homosexual as an adult. c. The adolescent should be referred for psychotherapy. d. The adolescent should be encouraged to share his feelings and experiences. These adolescents are at increased risk for health-damaging behaviors, not because of the sexual behavior itself, but because of society’s reaction to the behavior. The nurse’s first priority is to give the young man permission to discuss his feelings about this topic, knowing that the nurse will maintain confidentially, appreciate his feelings, and remain sensitive to his need to talk it. In recent studies among self-identified gay, lesbian, and bisexual adolescents, many of the adolescents report changing their self-labels one or more times during their adolescence. PTS: 1 DIF: Cognitive Level: Application REF: 1020 OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance 10. The school nurse tells adolescents in the clinic that confidentiality and privacy will be maintained unless a life-threatening situation arises. This practice is: a. Not appropriate in a school setting. b. Never appropriate because adolescents are minors. c. Important in establishing trusting relationships. d. Suggestive that the nurse is meeting his or her own needs. Health professionals who work with adolescents should consider the adolescents’ increasing independence and responsibility while maintaining privacy and ensuring confidentiality. However, circumstances may occur in which they are not able to maintain confidentiality, such as self-destructive behavior or maltreatment by others. Confidentiality and privacy are necessary to facilitate trust with this age group. The nurse must be aware of the limits placed on confidentiality by local jurisdiction. PTS: 1 DIF: Cognitive Level: Comprehension REF: 1020 OBJ: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment 11. Matt, age 14 years, seems to be always eating, although his weight is appropriate for his height. The best explanation for this is: a. This is normal because of increase in body mass. b. This is abnormal and suggestive of future obesity. c. His caloric intake would have to be excessive. d. He is substituting food for unfilled needs. In adolescence, nutritional needs are closely related to the increase in body mass. The peak requirements occur in the years of maximal growth. The caloric and protein requirements are higher than at almost any other time of life. This describes the expected eating pattern for young adolescents as long as weight and height are appropriate; obesity and substitution of food for unfilled needs are not concerns. PTS: 1 DIF: Cognitive Level: Comprehension REF: 1023 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 12. Which predisposes the adolescent to feel an increased need for sleep? a. An inadequate diet b. Rapid physical growth c. Decreased activity that contributes to a feeling of fatigue d. The lack of ambition typical of this age group During growth spurts, the need for sleep is increased. Rapid physical growth, the tendency toward overexertion, and the overall increased activity of this age contribute to fatigue. PTS: 1 DIF: Cognitive Level: Comprehension REF: 1024 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 13. The most common cause of death in the adolescent age-group involves: a. Drownings. c. Drug overdoses. b. Firearms. d. Motor vehicles. The leading cause of all adolescent deaths in the United States is motor vehicle accidents. Drownings, firearms, and drug overdoses are major concerns in adolescence but do not cause the majority of deaths. PTS: 1 DIF: Cognitive Level: Comprehension REF: 1040 OBJ: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment 14. Which statement is true about smoking in adolescence? a. Smoking is related to other high-risk behaviors. b. Smoking is more common among athletes. c. Smoking is less common when the adolescent’s parent(s) smokes. d. Smoking among adolescents is becoming more prevalent. Cigarettes are considered a gateway drug. Teenagers who smoke are 11.4 times more likely to use an illicit drug. Teens who refrain from smoking often have a desire to succeed in athletics. If a parent smokes, it is more likely that the teen will smoke. Cigarette smoking has declined among all groups since the 1990s. PTS: 1 DIF: Cognitive Level: Comprehension REF: 1040 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 15. The nurse is completing a health history with a 16-year-old male. He informs the nurse that he has started using smokeless tobacco after he plays baseball. Which information regarding smokeless tobacco would be most correct for the nurse to provide to this teen? a. Not addicting. b. Proven to be carcinogenic. c. Easy to stop using. d. A safe alternative to cigarette smoking. Smokeless tobacco is a popular substitute for cigarettes and poses serious health hazards to children and adolescents. Smokeless tobacco is associated with cancer of the mouth and jaw. Smokeless tobacco is just as addictive as cigarettes. Although teens believe that it is easy to stop using smokeless tobacco, this is not the case. A popular belief is that smokeless tobacco is a safe alternative to cigarettes; this has been proven incorrect. Half of all teens who use smokeless tobacco agree that it poses significant health risks. PTS: 1 DIF: Cognitive Level: Application REF: 1040 OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity 16. A 14-year-old boy and his parents are concerned about bilateral breast enlargement. The nurse’s discussion of this should be based on knowing that: a. This is usually benign and temporary. b. This is usually caused by Klinefelter’s syndrome. c. Administration of estrogen effectively reduces gynecomastia. d. Administration of testosterone effectively reduces gynecomastia. The male breast responds to hormone changes. Some degree of bilateral or unilateral breast enlargement occurs frequently in boys during puberty. This is not a manifestation of Klinefelter’s syndrome. Administration of estrogen or testosterone will have no effect on the reduction of breast tissue and may aggravate the condition. PTS: 1 DIF: Cognitive Level: Comprehension REF: 1030 OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity 17. Which statement is correct about childhood obesity? a. Heredity is an important factor in the development of obesity. b. Childhood obesity in the United States is decreasing. c. Childhood obesity is the result of inactivity. d. Childhood obesity can be attributed to an underlying disease in most cases. Heredity is an important fact that contributes to obesity. Identical twins reared apart tend to resemble their biologic parents to a greater extent than their adoptive parents. It is difficult to distinguish between hereditary and environmental factors. The rate of childhood obesity has increased so dramatically that it has now reached epidemic proportions. Inactivity is an important contributing factor; however, obesity is the result of a combination of a number of other factors. Fewer than 5% of all cases of obesity can be linked to underlying disease. PTS: 1 DIF: Cognitive Level: Comprehension REF: 1032 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity 18. The psychologic effects of being obese during adolescence include: a. Sexual promiscuity. b. Poor body image. c. Memory having no effect on eating behavior. d. Accurate body image but self-deprecating attitude. Common emotional consequences of obesity include poor body image, low self-esteem, social isolation, and feelings of depression and isolation. Sexual promiscuity is an unlikely effect of obesity. The obese adolescent often substitutes food for affection. Eating behaviors are closely related to memory. Memory and appetite are closely linked and can be modified over time with treatment. Obese adolescents most often have a very poor self-image. PTS: 1 DIF: Cognitive Level: Comprehension REF: 1031 OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 19. Anorexia nervosa may best be described as: a. Occurring most frequently in adolescent males. b. Occurring most frequently in adolescents from lower socioeconomic groups. c. Resulting from a posterior pituitary disorder. d. Resulting in severe weight loss in the absence of obvious physical causes. The etiology of anorexia remains unclear, but a distinct psychologic component is present. The diagnosis is based primarily on psychologic and behavioral criteria. Anorexia nervosa is observed more commonly in adolescent girls and young women. It does not occur most frequently in adolescents from a lower socioeconomic group. In reality, anorexic adolescents are often from families of means who have high parental expectations for achievement. Anorexia is a psychiatric disorder. PTS: 1 DIF: Cognitive Level: Comprehension REF: 1035 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity 20. The weight loss of anorexia nervosa is often triggered by: a. Sexual abuse. c. Independence from family. b. School failure. d. Traumatic interpersonal conflict. Weight loss may be triggered by a typical adolescent crisis such as the onset of menstruation or a traumatic interpersonal incident; situations of severe family stress such as parental separation or divorce; or circumstances in which the young person lacks personal control, such as being teased, changing schools, or entering college. There may in fact be a history of sexual abuse; however, this is not the trigger. These adolescents are often overachievers who are successful in school, not failures in school. The adolescent is most often enmeshed with his or her family. PTS: 1 DIF: Cognitive Level: Comprehension REF: 1036 OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 21. Which statement is most descriptive of bulimia during adolescence? a. Strong sense of control over eating behavior b. Feelings of elation after the binge-purge cycle c. Profound lack of awareness that the eating pattern is abnormal d. Weight that can be normal, slightly above normal, or below normal Individuals with bulimia are of normal weight or more commonly slightly above normal weight. Those who also restrict their intake can become severely underweight. Behavior related to this eating disorder is secretive, frenzied, and out of control. These cycles are followed by self-deprecating thoughts and a depressed mood. These young women are keenly aware that this eating pattern is abnormal. PTS: 1 DIF: Cognitive Level: Comprehension REF: 1035 OBJ: Nursing Process: Diagnosis MSC: Client Needs: Psychosocial Integrity 22. The nurse is caring for an adolescent brought to the hospital with acute drug toxicity. Cocaine is believed to be the drug involved. Data collection should include the: a. Mode of administration. b. Actual content of the drug. c. Function the drug plays in the adolescent’s life. d. Adolescent’s level of interest in rehabilitation. When the drug is questionable or unknown, every effort must be made to determine the type, amount of drug taken, the mode and time of administration, and factors relating to the onset of presenting symptoms. Because the actual content of most street drugs is highly questionable, this information would be difficult to obtain. It is helpful to know the pattern of use but not essential during this emergency. This is an inappropriate time for an evaluation about the level of interest in rehabilitation. PTS: 1 DIF: Cognitive Level: Comprehension REF: 1043 OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 23. An adolescent girl tells the nurse that she has suicidal thoughts. The nurse asks her if she has a specific plan. Asking this should be considered: a. An appropriate part of the assessment. b. Not a critical part of the assessment. c. Suggesting that the adolescent needs a plan. d. Encouraging the adolescent to devise a plan. Routine health assessments of adolescents should include questions that assess the presence of suicidal ideation or intent. Questions such as “Have you ever developed a plan to hurt yourself or kill yourself?” should be part of that assessment. Threats of suicide should always be taken seriously and evaluated. Suggesting that the adolescent needs a plan and encouraging her to devise this plan would be inappropriate statements by the nurse. PTS: 1 DIF: Cognitive Level: Comprehension REF: 1044 OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 24. The nurse is explaining Tanner staging to an adolescent and her mother. Which statement best describes Tanner staging? a. Predictable stages of puberty that are based on chronologic age b. Staging of puberty based on the initiation of menarche and nocturnal emissions c. Predictable stages of puberty that are based on primary and secondary sexual characteristics d. Staging of puberty based on the initiation of primary sexual characteristics Tanner sexual-maturing ratings are based on the development of stages of primary and secondary sexual characteristics. Tanner stages are not based on chronologic age. The age at which an adolescent enters puberty is variable. The puberty stage in girls begins with breast development. The puberty stage in boys begins with genital enlargement. Primary sexual characteristics are not the sole basis of Tanner staging. PTS: 1 DIF: Cognitive Level: Comprehension REF: 1011 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 25. Which behavior suggests appropriate psychosocial development in the adolescent? a. The adolescent seeks validation for socially acceptable behavior from older adults. b. The adolescent is self-absorbed and self-centered and has sudden mood swings. c. Adolescents move from peers and enjoy spending time with family members. d. Conformity with the peer group increases in late adolescence. During adolescence, energy is focused within. Adolescents concentrate on themselves in an effort to determine who they are or who they will be. Adolescents are likely to be impulsive and impatient. Parents often describe their teenager as being “self-centered” or “lazy.” The peer group validates acceptable behavior during adolescence. Adolescents move from family and enjoy spending time with peers. Adolescents also spend time alone; they need this time to think and concentrate on themselves. Conformity becomes less important in late adolescence. PTS: 1 DIF: Cognitive Level: Comprehension REF: 1021 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 26. The parents of a 15-year-old girl are concerned that their adolescent spends too much time looking in the mirror. Which statement is the most appropriate for the nurse to make? a. “Your teenager needs clearer and stricter limits about her behavior.” b. “Your teenager needs more responsibility at home.” c. “During adolescence this behavior is not unusual.” d. “The behavior is abnormal and needs further investigation.” Egocentric and narcissistic behavior is normal during this period of development. The teenager is seeking a personal identity. Stricter limits are not an appropriate response for a behavior that is part of normal development. More responsibility at home is not an appropriate response for this situation. The behavior is normal and needs no further investigation. PTS: 1 DIF: Cognitive Level: Application REF: 1020 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 27. Which statement is the most appropriate advice to give parents of a 16-year-old girl who is rebellious? a. “You need to be stricter so that your teen stops trying to test the limits.” b. “You need to collaborate with your daughter and set limits that are perceived as being reasonable.” c. “Increasing your teen’s involvement with her peers will improve her self-esteem.” d. “Allow your teenager to choose the type of discipline that is used in your home.” Allowing teenagers to choose between realistic options and offering consistent and structured discipline typically enhances cooperation and decreases rebelliousness. Structure helps adolescents to feel more secure and assists them in the decision-making process. Setting stricter limits typically does not decrease rebelliousness or decrease testing of parental limits. Increasing peer involvement does not typically increase self-esteem. PTS: 1 DIF: Cognitive Level: Application REF: 1034 OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance 28. Which statement by the nurse is most appropriate to a 15-year-old whose friend has mentioned suicide? a. “Tell your friend to come to the clinic immediately.” b. “You need to gather details about your friend’s suicide plan.” c. “Your friend’s threat needs to be taken seriously and immediate help for your friend is important.” d. “If your friend mentions suicide a second time, you will want to get your friend some help.” Suicide is the third most common cause of death among American adolescents. A suicide threat from an adolescent serves as a dramatic message to others and should be taken seriously. Adolescents at risk should be targeted for supportive guidance and counseling before a crisis occurs. Instructing a 15-year-old to tell a friend to come to the clinic immediately provides the teen with limited information and does not address the concern. It is important to determine whether a person threatening suicide has a plan of action; however, the best information for the 15-year-old to have is that all threats of suicide should be taken seriously and immediate help is important. Taking time to gather details or waiting until the teen discusses it a second time may be too late. PTS: 1 DIF: Cognitive Level: Application REF: 1044 OBJ: Nursing Process: Evaluation MSC: Client Needs: Psychosocial Integrity 29. When planning care for adolescents, the nurse should: a. Teach parents first, and they, in turn, will teach the teenager. b. Provide information for their long-term health needs because teenagers respond best to long-range planning. c. Maintain the parents’ role by providing explanations for treatment and procedures to the parents only. d. Give information privately to adolescents about how they can manage the specific problems that they identify. Problems that teenagers identify and are interested in are typically the problems that they are the most willing to address. Confidentiality is important to adolescents. Adolescents prefer to confer privately (without parents) with the nurse and health care provider. Teenagers are socially and cognitively at the developmental stage where the health care provider can teach them. The nurse must keep in mind that teenagers are more interested in immediate health care needs than in long-term needs. PTS: 1 DIF: Cognitive Level: Application REF: 1022 OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance 30. A 17-year-old tells the nurse that he is not having sex because it would make his parents very angry. This response indicates that the adolescent has a developmental lag in which area? a. Cognitive development c. Psychosocial development b. Moral development d. Psychosexual development The appropriate moral development for a 17-year-old would include evidence that the teenager has internalized a value system and does not depend on parents to determine right and wrong behaviors. Adolescents who remain concrete thinkers may never advance beyond conformity to please others and avoid punishment. Cognitive development is related to moral development, but it is not the pivotal point in determining right and wrong behaviors. Identity formation is the psychosocial development task. Energy is focused within the adolescent, who exhibits behavior that is self-absorbed and egocentric. Although a task during adolescence is the development of a sexual identity, the teenager’s dependence on the parents’ sanctioning of right or wrong behavior is more appropriately related to moral development. PTS: 1 DIF: Cognitive Level: Analysis REF: 1016 OBJ: Nursing Process: Evaluation MSC: Client Needs: Health Promotion and Maintenance 31. A nurse is teaching adolescent boys about pubertal changes. The first sign of pubertal change seen with boys is: a. Testicular enlargement. c. Scrotal enlargement. b. Facial hair. d. Voice deepens. The first sign of pubertal changes in boys is testicular enlargement in response to testosterone secretion, which usually occurs in Tanner stage 2. Slight pubic hair is present and the smooth skin texture of the scrotum is somewhat altered. As testosterone secretion increases, the penis, testes, and scrotum enlarge. During Tanner stages 4 and 5, rising levels of testosterone cause the voice to deepen and facial hair appears at the corners of the upper lip and chin. PTS: 1 DIF: Cognitive Level: Comprehension REF: 1011 OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance 32. A young adolescent boy tells the nurse he “feels gawky.” The nurse should explain that this occurs in adolescents because: a. Growth of the extremities and neck precedes growth in other areas. b. Growth is in the trunk and chest. c. The hip and chest breadth increases. d. The growth spurt occurs earlier in boys than it does in girls. 33. A nurse is reviewing hormone changes that occur during adolescence. The hormone that is responsible for the growth of beard, mustache, and body hair in the male is: a. Estrogen. c. Androgen. b. Pituitary hormone. d. Progesterone. 34. A nurse is caring for an adolescent hospitalized for cellulitis. The nurse notes that the adolescent experiences many “mood swings” throughout the day. The nurse interprets this behavior as: a. Requiring a referral to a mental health counselor. b. Requiring some further lab testing. c. Normal behavior. d. Related to feelings of depression. 35. The school nurse is discussing testicular self-examination with adolescent boys. Why is this important? a. Epididymitis is common during adolescence. b. Asymptomatic sexually transmitted diseases may be present. c. Testicular tumors during adolescence are generally malignant. d. Testicular tumors, although usually benign, are common during adolescence. 36. Young people with anorexia nervosa are often described as being: a. Independent. c. Conforming. b. Disruptive. d. Low achieving. .37. Which symptoms should the nurse expect to observe during the physical assessment of an adolescent girl with severe weight loss and disrupted metabolism associated with anorexia nervosa? a. Dysmenorrhea and oliguria b. Tachycardia and tachypnea c. Heat intolerance and increased blood pressure d. Lowered body temperature and brittle nails 38. An adolescent teen has bulimia. Which assessment finding should the nurse expect? a. Diarrhea c. Cold intolerance b. Amenorrhea d. Erosion of tooth enamel 39. A teen asks a nurse, “What is physical dependence in substance abuse?” Which is the correct response by the nurse? a. Problem that occurs in conjunction with addiction b. Involuntary physiologic response to drug c. Culturally defined use of drugs for purposes other than accepted medical purposes d. Voluntary behavior based on psychosocial needs 40. Which statement is most descriptive of central nervous system stimulants? a. They produce strong physical dependence. b. They can result in strong psychologic dependence. c. Withdrawal symptoms are life threatening. d. Acute intoxication can lead to coma. 41. A school nurse is conducting a class with adolescents on suicide. Which true statement about suicide should the nurse include in the teaching session? a. A sense of hopelessness and despair are a normal part of adolescence. b. Gay and lesbian adolescents are at a particularly high risk for suicide. c. Problem-solving skills are of limited value to the suicidal adolescent. d. Previous suicide attempts are not an indication of risk for completed suicides. 42. Which is the most commonly used method in completed suicides? a. Firearms c. Self-inflected laceration b. Drug overdose d. Carbon monoxide poisoning 43. Which is the most significant factor in distinguishing those who commit suicide from those who make suicidal attempts or threats? a. Social isolation c. Degree of depression b. Level of stress d. Desire to punish others 44. Research has shown that the most successful smoking cessation programs among teens include (select all that apply): a. Peer-led education and support. b. Information on the long-term effects of smoking. c. Programs including the media. d. School-based programs. e. Information on the immediate effects of smoking. , C, D, E 45. Injuries claim many lives during adolescence. Which factors contribute to early adolescents engaging in risk-taking behaviors (select all that apply)? a. Peer pressure b. A desire to master their environment c. Engagement in the process of separation from their parents d. A belief that they are invulnerable e. Impulsivity , D, E 46. Which screening tests should the school nurse perform for the adolescent (select all that apply)? a. Glucose b. Vision c. Hearing d. Cholesterol e. Scoliosis , C, E MATCHING Place in correct order the sequence of maturational changes for girls. Begin with the first change seen, sequencing to the last change. a. Growth of pubic hair d. Menstruation b. Rapid increase in height and weight e. Appearance of axillary hair c. Breast changes 47. First change 48. Second change 49. Third change 50. Fourth change 51. Fifth change 47. 48. 49. Chapter 36: Chronic Illness, Disability, and End-of-Life Care 1. The nurse case manager is planning a care conference about a young child who has complex health care needs and will soon be discharged home. Whom should the nurse invite to the conference? a. Family and nursing staff b. Social worker, nursing staff, and primary care physician c. Family and key health professionals involved in child’s care d. Primary care physician and key health professionals involved in child’s care 2. Lindsey, age 5 years, will be starting kindergarten next month. She has cerebral palsy, and it has been determined that she needs to be in a special education classroom. Her parents are tearful when telling the nurse about this and state that they did not realize that her disability was so severe. The best interpretation of this situation is that: a. This is a sign that parents are in denial. b. This is a normal anticipated time of parental stress. c. The parents need to learn more about cerebral palsy. d. The parents are used to having expectations that are too high. 3. Approach behaviors are coping mechanisms that result in a family’s movement toward adjustment and resolution of the crisis of having a child with a chronic illness or disability. What is considered an approach behavior in parents? a. Are unable to adjust to a progression of the disease or condition b. Anticipate future problems and seek guidance and answers c. Look for new cures without a perspective toward possible benefit d. Fail to recognize seriousness of child’s condition despite physical evidence 4. Families progress through various stages of reactions when a child is diagnosed with a chronic illness or disability. After the shock phase, a period of adjustment usually follows. This is often characterized by: a. Denial. c. Social reintegration. b. Guilt and anger. d. Acceptance of child’s limitations. 5. The nurse comes into the room of a child who was just diagnosed with a chronic disability. The child’s parents begin to yell at the nurse about a variety of concerns. The nurse’s best response is: a. “What is really wrong?” b. “Being angry is only natural.” c. “Yelling at me will not change things.” d. “I will come back when you settle down.” 6. A common parental reaction to a child with special needs is parental overprotection. Parental behavior suggestive of this includes: a. Giving inconsistent discipline. b. Providing consistent, strict discipline. c. Forcing child to help self, even when not capable. d. Encouraging social and educational activities not appropriate to child’s level of capability. 7. Most parents of children with special needs tend to experience chronic sorrow. This is characterized by: a. Lack of acceptance of the child’s limitation. b. Lack of available support to prevent sorrow. c. Periods of intensified sorrow when experiencing anger and guilt. d. Periods of intensified sorrow and loss that occur in waves over time. 8. Which intervention will encourage a sense of autonomy in a toddler with disabilities? a. Avoiding separation from family during hospitalizations b. Encouraging independence in as many areas as possible c. Exposing child to pleasurable experiences as much as possible d. Helping parents learn special care needs of their child 9. The feeling of guilt that the child “caused” the disability or illness is especially critical in which child? a. Toddler c. School-age child b. Preschooler d. Adolescent 10. Chris, age 9 years, has several physical disabilities. His father explains to the nurse that his son concentrates on what he can rather than cannot do and is as independent as possible. The nurse’s best interpretation of this is: a. The father is experiencing denial. b. The father is expressing his own views. c. Chris is using an adaptive coping style. d. Chris is using a maladaptive coping style. 11. The nurse is talking with the parent of a child newly diagnosed with a chronic illness. The parent is upset and tearful. The nurse asks, “With whom do you talk when something is worrying you?” This should be interpreted as: a. Inappropriate, because parent is so upset. b. A diversion of the present crisis to similar situations with which parent has dealt. c. An intervention to find someone to help parent. d. Part of assessing parent’s available support system. 12. The nurse is providing support to parents at the time their child is diagnosed with chronic disabilities. The nurse notices that the parents keep asking the same questions. The nurse should: a. Patiently continue to answer questions. b. Kindly refer them to someone else to answer their questions. c. Recognize that some parents cannot understand explanations. d. Suggest that they ask their questions when they are not upset. 13. The parents of a child born with disabilities ask the nurse for advice about discipline. The nurse’s response should be based on knowledge that discipline is: a. Essential for the child. b. Too difficult to implement with a special-needs child. c. Not needed unless the child becomes problematic. d. Best achieved with punishment for misbehavior. 14. Kelly, age 8 years, will soon be able to return to school after an injury that resulted in several severe, chronic disabilities. What is the most appropriate action by the school nurse? a. Recommending that Kelly’s parents attend school at first to prevent teasing b. Preparing Kelly’s classmates and teachers for changes they can expect c. Referring Kelly to a school where the children have chronic disabilities similar to hers d. Discussing with Kelly and her parents the fact that her classmates will not accept her as they did before 15. A 16-year-old boy with a chronic illness has recently become rebellious and is taking risks such as missing doses of his medication. The nurse should explain to his parents that: a. He needs more discipline. b. He needs more socialization with peers. c. This is part of normal adolescence. d. This is how he is asking for more parental control. 16. A preschooler is found digging up a pet bird that was recently buried after it died. The best explanation for this behavior is that: a. He has a morbid preoccupation with death. b. He is looking to see if a ghost took it away. c. The loss is not yet resolved, and professional counseling is needed. d. Reassurance is needed that the pet has not gone somewhere else. 17. At what age do most children have an adult concept of death as being inevitable, universal, and irreversible? a. 4 to 5 years c. 9 to 11 years b. 6 to 8 years d. 12 to 16 years 18. What is most descriptive of a school-age child’s reaction to death? a. Is very interested in funerals and burials b. Has little understanding of words such as forever c. Imagines the deceased person to be still alive d. Has an idealistic view of the world and criticizes funerals as barbaric 19. At what developmental period do children have the most difficulty coping with death, particularly if it is their own? a. Toddlerhood c. School-age b. Preschool d. Adolescence 20. A school-age child is diagnosed with a life-threatening illness. The parents want to protect their child from knowing the seriousness of the illness. The nurse should explain that: a. This will help the child cope effectively by denial. b. This attitude is helpful to give parents time to cope. c. Terminally ill children know when they are seriously ill. d. Terminally ill children usually choose not to discuss the seriousness of their illness. 21. The nurse is caring for a child who has just died. The parents ask to be left alone so that they can rock their child one more time. The nurse should: a. Grant their request. b. Assess why they feel that this is necessary. c. Discourage this because it will only prolong their grief. d. Kindly explain that they need to say good-bye to their child now and leave. 22. The nurse is talking with the parents of a child who died 6 months ago. They sometimes still “hear” the child’s voice and have trouble sleeping. They describe feeling “empty” and depressed. The nurse should recognize that: a. These are normal grief responses. b. The pain of the loss is usually less by this time. c. These grief responses are more typical of the early stages of grief. d. This grieving is essential until the pain is gone and the child is gradually forgotten. 23. At the time of a child’s death, the nurse tells his mother, “We will miss him so much.” The best interpretation of this is that the nurse is: a. Pretending to be experiencing grief. b. Expressing personal feelings of loss. c. Denying the mother’s sense of loss. d. Talking when listening would be better. 24. An appropriate nursing intervention when providing comfort and support for a child whose death is imminent is to: a. Limit care to essentials. b. Avoid playing music near the child. c. Explain to the child the need for constant measurement of vital signs. d. Whisper to the child instead of using a normal voice. 25. What is the most appropriate response to a school-age child who asks if she can talk to her dying sister? a. “You need to speak loudly so she can hear you.” b. “Holding her hand would be better because at this point she can’t hear you.” c. “Although she can’t hear you, she can feel your presence so sit close to her.” d. “Even though she will probably not answer you, she can still hear what you say to her.” 26. What is a priority nursing diagnosis for the preschool child with chronic illness? a. Risk for Delayed Growth and Development related to chronic illness or disability b. Chronic Pain related to frequent injections c. Anticipatory Grieving related to impending death d. Anxiety related to frequent hospitalizations 27. Which represents a common best practice in the provision of services to children with chronic or complex conditions? a. Care is focused on the child’s chronologic age. b. Children with complex conditions are integrated into regular classrooms. c. Disabled children are less likely to be cared for by their families. d. Children with complex conditions are placed in residential treatment facilities. 28. Which intervention will encourage a sense of autonomy in a toddler with disabilities? a. Avoid separation from family during hospitalizations. b. Encourage independence in as many areas as possible. c. Expose child to pleasurable experiences as much as possible. d. Help parents learn special care needs of their child. 29. Which is the most appropriate nursing intervention to promote normalization in a school-age child with a chronic illness? a. Give child as much control as possible. b. Ask child’s peer to make child feel normal. c. Convince child that nothing is wrong with him or her. d. Explain to parents that family rules for the child do not need to be the same as for healthy siblings. 30. Nursing interventions to help the siblings of a child with a complex or chronic condition cope include: a. Explaining to the siblings that embarrassment is unhealthy. b. Encouraging the parents not to expect siblings to help them care for the child with special needs. c. Providing information to the siblings about the child’s condition only as they request it. d. Suggesting to the parents ways of showing gratitude to the siblings who help care for the child with a disability or chronic condition. 31. Which term best describes a multidisciplinary approach to the management of a terminal illness that focuses on symptom control and support? a. Dying care c. Restorative care b. Curative care d. Palliative care 32. Which best describes how preschoolers react to the death of a loved one? a. The preschooler is too young to have a concept of death. b. A preschooler is likely to feel guilty and responsible for the death. c. Grief is acute but does not last long at this age. d. Grief is usually expressed in the same way in which the adults in the preschooler’s life are expressing grief. 33. A cure is no longer possible for a young child with cancer. The nursing staff recognizes that the goal of treatment must shift from cure to palliation. Which is an important consideration at this time? a. The family is included in the decision to shift the goals of treatment. b. The decision must be made by the health professionals involved in the child’s care. c. The family needs to understand that palliative care takes place in the home. d. The decision should not be communicated to the family because it will encourage a sense of hopelessness. 34. The nurse and a new nurse are caring for a child who will require palliative care. Which statement made by the new nurse would indicate a correct understanding of palliative care? a. “Palliative care serves to hasten death and make the process easier for the family.” b. “Palliative care provides pain and symptom management for the child.” c. “The goal of palliative care is to place the child in a hospice setting at the end of life.” d. “The goal of palliative care is to act as the liaison between the family, child, and other health care professionals.” 35. A nurse is planning palliative care for a child with severe pain. Which should the nurse expect to be prescribed for pain relief? a. Opioids as needed c. Distraction and relaxation techniques b. Opioids on a regular schedule d. Nonsteroidal antiinflammatory drugs 36. What should the nurse identify as major fears in the preschool child who is hospitalized with a chronic illness (select all that apply)? a. Altered body image b. Separation from peer group c. Bodily injury d. Mutilation e. Being left alone , D, E 37. Which describe avoidance behaviors a parent may exhibit when learning that his or her child has a chronic condition (select all that apply)? a. Refuses to agree to treatment b. Shares burden of disorder with others c. Verbalizes possible loss of child d. Withdraws from outside world e. Punishes self because of guilt and shame , D, E 38. Which are appropriate statements the nurse should make to parents after the death of their child (select all that apply)? a. “We feel so sorry that we couldn’t save your child.” b. “Your child isn’t suffering anymore.” c. “I know how you feel.” d. “You’re feeling all the pain of losing a child.” e. “You are still young enough to have another baby.” , D 39. A nurse is caring for a child who is near death. Which physical signs indicate the child is approaching death (select all that apply)? a. Body feels warm b. Tactile sensation decreasing c. Speech becomes rapid d. Change in respiratory pattern e. Difficulty swallowing , D, E [Show More]

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