Chapter 9 My Nursing Test Banks

Ball/Bindler/Cowen, Principles of Pediatric Nursing: Caring for Children 6th Edition Test Bank
Chapter 9

Question 1

Type: MCSA

An adolescent female presents at a nurse practitioners office and requests a signature for working papers. The nurse reviews her chart and notes that the last physical examination was two years ago. In addition to providing the signature for the working papers, what else should the nurse use this visit?

1. An opportunity to discuss birth-control measures

2. A time to discuss exercise and sports participation

3. A health-supervision opportunity

4. A chance to discuss the importance of pursuing post secondary education

Correct Answer: 3

Rationale 1: All visits should be used as health-promotion and health-supervision visits. While discussing birth control, exercise, and future plans is important, these can be included in the overall health-supervision protocols.

Rationale 2: All visits should be used as health-promotion and health-supervision visits. While discussing birth control, exercise, and future plans is important, these can be included in the overall health-supervision protocols.

Rationale 3: All visits should be used as health-promotion and health-supervision visits. While discussing birth control, exercise, and future plans is important, these can be included in the overall health-supervision protocols.

Rationale 4: All visits should be used as health-promotion and health-supervision visits. While discussing birth control, exercise, and future plans is important, these can be included in the overall health-supervision protocols.

Global Rationale: All visits should be used as health-promotion and health-supervision visits. While discussing birth control, exercise, and future plans is important, these can be included in the overall health-supervision protocols.

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub: 

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: LO 9.5 Synthesize data from history and examination with knowledge of development to intervene with the school-age child, adolescent, and family during health supervision visits.

Question 2

Type: MCMA

An adolescent is accompanied by the mother for an annual physical examination. The nurse is aware of privacy issues related to the adolescent. While the mother is in the room, the nurse should avoid which questions?

Standard Text: Select all that apply.

1. Sexual activity

2. Cigarette smoking

3. School performance

4. Use of alcohol

5. Car seatbelt use

Correct Answer: 1,2,4

Rationale 1: The nurse must maintain the nurseclient relationship, which is between the nurse and the adolescent, and the nurse must maintain confidentiality. Therefore, the nurse cannot ask any personal questions while the mother is in the room, such as those related to sexual activity, drug and alcohol use, and smoking cigarettes. The nurse can ask general questions about seatbelt use and academic performance without breaching confidentiality.

Rationale 2: The nurse must maintain the nurseclient relationship, which is between the nurse and the adolescent, and the nurse must maintain confidentiality. Therefore, the nurse cannot ask any personal questions while the mother is in the room, such as those related to sexual activity, drug and alcohol use, and smoking cigarettes. The nurse can ask general questions about seatbelt use and academic performance without breaching confidentiality.

Rationale 3: The nurse must maintain the nurseclient relationship, which is between the nurse and the adolescent, and the nurse must maintain confidentiality. Therefore, the nurse cannot ask any personal questions while the mother is in the room, such as those related to sexual activity, drug and alcohol use, and smoking cigarettes. The nurse can ask general questions about seatbelt use and academic performance without breaching confidentiality.

Rationale 4: The nurse must maintain the nurseclient relationship, which is between the nurse and the adolescent, and the nurse must maintain confidentiality. Therefore, the nurse cannot ask any personal questions while the mother is in the room, such as those related to sexual activity, drug and alcohol use, and smoking cigarettes. The nurse can ask general questions about seatbelt use and academic performance without breaching confidentiality.

Rationale 5: The nurse must maintain the nurseclient relationship, which is between the nurse and the adolescent, and the nurse must maintain confidentiality. Therefore, the nurse cannot ask any personal questions while the mother is in the room, such as those related to sexual activity, drug and alcohol use, and smoking cigarettes. The nurse can ask general questions about seatbelt use and academic performance without breaching confidentiality.

Global Rationale: The nurse must maintain the nurseclient relationship, which is between the nurse and the adolescent, and the nurse must maintain confidentiality. Therefore, the nurse cannot ask any personal questions while the mother is in the room, such as those related to sexual activity, drug and alcohol use, and smoking cigarettes. The nurse can ask general questions about seatbelt use and academic performance without breaching confidentiality.

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub: 

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: LO 9.3 Apply communication skills to interactions with school-age children, adolescents, and their families.

Question 3

Type: MCMA

The school nurse performs screenings on all students in the middle school. In addition, the nurse will perform selected screenings on individual school-age children. When planning the screenings for the year, which screenings will the nurse include for all school-age children?

Standard Text: Select all that apply.

1. Hearing

2. Height and weight

3. Blood-pressure measurement

4. Hepatitis B profile serology

5. Chest x-ray

Correct Answer: 1,2,3

Rationale 1: Routine screening for school-age children include hearing, checking for height and weight, and blood-pressure measurements. The hepatitis B profile is only needed once, prior to administration of hepatitis B vaccine; however, this is not a required screening for all school-age children. A chest x-ray is not a routine screening test for school-age children.

Rationale 2: Routine screening for school-age children include hearing, checking for height and weight, and blood-pressure measurements. The hepatitis B profile is only needed once, prior to administration of hepatitis B vaccine; however, this is not a required screening for all school-age children. A chest x-ray is not a routine screening test for school-age children.

Rationale 3: Routine screening for school-age children include hearing, checking for height and weight, and blood-pressure measurements. The hepatitis B profile is only needed once, prior to administration of hepatitis B vaccine; however, this is not a required screening for all school-age children. A chest x-ray is not a routine screening test for school-age children.

Rationale 4: Routine screening for school-age children include hearing, checking for height and weight, and blood-pressure measurements. The hepatitis B profile is only needed once, prior to administration of hepatitis B vaccine; however, this is not a required screening for all school-age children. A chest x-ray is not a routine screening test for school-age children.

Rationale 5: Routine screening for school-age children include hearing, checking for height and weight, and blood-pressure measurements. The hepatitis B profile is only needed once, prior to administration of hepatitis B vaccine; however, this is not a required screening for all school-age children. A chest x-ray is not a routine screening test for school-age children.

Global Rationale: Routine screening for school-age children include hearing, checking for height and weight, and blood-pressure measurements. The hepatitis B profile is only needed once, prior to administration of hepatitis B vaccine; however, this is not a required screening for all school-age children. A chest x-ray is not a routine screening test for school-age children.

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub: 

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: LO 9.1 Identify the major health concerns of the school-age and adolescent years.

Question 4

Type: MCSA

A school nurse is performing annual height and weight screening. The nurse notes that three females who are close friends each lost 15 pounds over the past year. What is the priority nursing action in this situation?

1. Call the respective parents to discuss the eating patterns of each adolescent.

2. Speak with the girls in a group to discuss the problems associated with anorexia nervosa.

3. Refer these adolescents to the school psychologist.

4. Obtain a nutritional history for each of these adolescents.

Correct Answer: 4

Rationale 1: The school nurse must evaluate why these three friends have all lost 15 pounds in one year. The best way to begin this assessment is to obtain a nutritional history for each client. Speaking with the parents would not be appropriate at this time. Discussing anorexia nervosa is too extreme, as is referring the adolescents to a school psychologist without performing a complete nursing assessment.

Rationale 2: The school nurse must evaluate why these three friends have all lost 15 pounds in one year. The best way to begin this assessment is to obtain a nutritional history for each client. Speaking with the parents would not be appropriate at this time. Discussing anorexia nervosa is too extreme, as is referring the adolescents to a school psychologist without performing a complete nursing assessment.

Rationale 3: The school nurse must evaluate why these three friends have all lost 15 pounds in one year. The best way to begin this assessment is to obtain a nutritional history for each client. Speaking with the parents would not be appropriate at this time. Discussing anorexia nervosa is too extreme, as is referring the adolescents to a school psychologist without performing a complete nursing assessment.

Rationale 4: The school nurse must evaluate why these three friends have all lost 15 pounds in one year. The best way to begin this assessment is to obtain a nutritional history for each client. Speaking with the parents would not be appropriate at this time. Discussing anorexia nervosa is too extreme, as is referring the adolescents to a school psychologist without performing a complete nursing assessment.

Global Rationale: The school nurse must evaluate why these three friends have all lost 15 pounds in one year. The best way to begin this assessment is to obtain a nutritional history for each client. Speaking with the parents would not be appropriate at this time. Discussing anorexia nervosa is too extreme, as is referring the adolescents to a school psychologist without performing a complete nursing assessment.

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub: 

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: LO 9.4 Apply assessment skills to plan data-gathering methods for nutrition, physical activity, and mental health status of youth.

Question 5

Type: MCSA

An school-age client who recently moved to a new school in a different town presents to an ambulatory care center and describes the following: I have no friends in my new school, and I no longer want to go to play soccer. I know I will be lonely there, too. Which of these takes priority when speaking with the school-age client?

1. Helping the school-age client realize the value of soccer

2. Promoting healthy mental-health outcomes

3. Acknowledging the fact that it takes several months to make new friends at a new school

4. Stressing the importance of remaining in a close parentchild relationship during these stressful times

Correct Answer: 2

Rationale 1: The school-age client is obviously lonely with the move to the new school. The nurse should focus on appropriate coping skills, which will enhance good mental-health outcomes for the child. It would not be appropriate to discuss the importance of soccer at this time, since the school-age client must deal with the loss of friends and developing new friendships first. The parentchild relationship should not be used as a substitute for the development of new peer relationships.

Rationale 2: The school-age client is obviously lonely with the move to the new school. The nurse should focus on appropriate coping skills, which will enhance good mental-health outcomes for the child. It would not be appropriate to discuss the importance of soccer at this time, since the school-age client must deal with the loss of friends and developing new friendships first. The parentchild relationship should not be used as a substitute for the development of new peer relationships.

Rationale 3: The school-age client is obviously lonely with the move to the new school. The nurse should focus on appropriate coping skills, which will enhance good mental-health outcomes for the child. It would not be appropriate to discuss the importance of soccer at this time, since the school-age client must deal with the loss of friends and developing new friendships first. The parentchild relationship should not be used as a substitute for the development of new peer relationships.

Rationale 4: The school-age client is obviously lonely with the move to the new school. The nurse should focus on appropriate coping skills, which will enhance good mental-health outcomes for the child. It would not be appropriate to discuss the importance of soccer at this time, since the school-age client must deal with the loss of friends and developing new friendships first. The parentchild relationship should not be used as a substitute for the development of new peer relationships.

Global Rationale: The school-age client is obviously lonely with the move to the new school. The nurse should focus on appropriate coping skills, which will enhance good mental-health outcomes for the child. It would not be appropriate to discuss the importance of soccer at this time, since the school-age client must deal with the loss of friends and developing new friendships first. The parentchild relationship should not be used as a substitute for the development of new peer relationships.

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub: 

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: LO 9.1 Identify the major health concerns of the school-age and adolescent years.

Question 6

Type: MCSA

An adolescent reports participating in an exercise program at school each Wednesday throughout the school year. Further history reveals that the adolescent does not participate in any other physical activities. Which outcome is most appropriate for this adolescent?

1. The adolescent is reporting information consistent with what 60 percent of adolescents report as participation in physical activities.

2. The adolescent is not meeting the recommendations of the Healthy People 2020 initiative.

3. The adolescent should be encouraged to continue this program of exercise, since something is better than nothing.

4. The adolescent should be encouraged to vigorously exercise for at least five minutes each day.

Correct Answer: 2

Rationale 1: In this scenario, the adolescent is not receiving the recommended amount of exercise to support good health habits. Encouraging the adolescent to continue as is or to exercise vigorously for five minutes each day also is not consistent with current recommendations. Suggesting that something is better than nothing is not good practice.

Rationale 2: In this scenario, the adolescent is not receiving the recommended amount of exercise to support good health habits. Encouraging the adolescent to continue as is or to exercise vigorously for five minutes each day also is not consistent with current recommendations. Suggesting that something is better than nothing is not good practice.

Rationale 3: In this scenario, the adolescent is not receiving the recommended amount of exercise to support good health habits. Encouraging the adolescent to continue as is or to exercise vigorously for five minutes each day also is not consistent with current recommendations. Suggesting that something is better than nothing is not good practice.

Rationale 4: In this scenario, the adolescent is not receiving the recommended amount of exercise to support good health habits. Encouraging the adolescent to continue as is or to exercise vigorously for five minutes each day also is not consistent with current recommendations. Suggesting that something is better than nothing is not good practice.

Global Rationale: In this scenario, the adolescent is not receiving the recommended amount of exercise to support good health habits. Encouraging the adolescent to continue as is or to exercise vigorously for five minutes each day also is not consistent with current recommendations. Suggesting that something is better than nothing is not good practice.

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub: 

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: LO 9.5 Synthesize data from history and examination with knowledge of development to intervene with the school-age child, adolescent, and family during health supervision visits.

Question 7

Type: MCSA

An adolescent reports the following: I get up at 6 am, I attend early-morning band classes three times each week, I play sports for two hours each day after school, and homework takes me three hours each night. I always feel tired. Which question by the nurse is most appropriate based on this information?

1. How many hours of sleep do you get each night?

2. Do you consume foods high in iron?

3. Do you think you are doing too much?

4. Have you considered talking with your teachers about decreasing your homework, since you have so many extracurricular activities?

Correct Answer: 1

Rationale 1: The data in this scenario reveals very little time for sleep; therefore, the history should focus on sleep patterns.

Rationale 2: The data in this scenario reveals very little time for sleep; therefore, the history should focus on sleep patterns.

Rationale 3: The data in this scenario reveals very little time for sleep; therefore, the history should focus on sleep patterns.

Rationale 4: The data in this scenario reveals very little time for sleep; therefore, the history should focus on sleep patterns.

Global Rationale: The data in this scenario reveals very little time for sleep; therefore, the history should focus on sleep patterns.

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub: 

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: LO 9.4 Apply assessment skills to plan data-gathering methods for nutrition, physical activity, and mental health status of youth.

Question 8

Type: MCSA

The nurse working in the clinic includes an adolescent history in every client intake interview. Which issue should the nurse address when the parents are not present?

1. Possible domestic violence

2. Teen job responsibilities

3. Activities that are done as a family

4. The adolescents role in the family

Correct Answer: 1

Rationale 1: If domestic violence is suspected, it would only be appropriate to ask these questions when the teenager is alone with the nurse or healthcare provider.

Rationale 2: If domestic violence is suspected, it would only be appropriate to ask these questions when the teenager is alone with the nurse or healthcare provider.

Rationale 3: If domestic violence is suspected, it would only be appropriate to ask these questions when the teenager is alone with the nurse or healthcare provider.

Rationale 4: If domestic violence is suspected, it would only be appropriate to ask these questions when the teenager is alone with the nurse or healthcare provider.

Global Rationale: If domestic violence is suspected, it would only be appropriate to ask these questions when the teenager is alone with the nurse or healthcare provider.

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub: 

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: LO 9.3 Apply communication skills to interactions with school-age children, adolescents, and their families.

Question 9

Type: MCSA

The nurse is reviewing the immunization record of an adolescent who will be seen later in the day. Which item in the clients history makes heptatis B status a priority?

1. Chronic acne

2. Overuse injuries from playing varsity sports

3. Chronic asthma

4. Plans to get a tattoo

Correct Answer: 4

Rationale 1: The adolescent who is most at-risk in the scenario presented is the teen who is planning on getting a tattoo. Adolescents with chronic acne or asthma do not have an increased risk for hepatitis B, since transmission has nothing to do with a diagnosis of acne. Overuse of muscles while playing sports is not related to development of hepatitis B.

Rationale 2: The adolescent who is most at-risk in the scenario presented is the teen who is planning on getting a tattoo. Adolescents with chronic acne or asthma do not have an increased risk for hepatitis B, since transmission has nothing to do with a diagnosis of acne. Overuse of muscles while playing sports is not related to development of hepatitis B.

Rationale 3: The adolescent who is most at-risk in the scenario presented is the teen who is planning on getting a tattoo. Adolescents with chronic acne or asthma do not have an increased risk for hepatitis B, since transmission has nothing to do with a diagnosis of acne. Overuse of muscles while playing sports is not related to development of hepatitis B.

Rationale 4: The adolescent who is most at-risk in the scenario presented is the teen who is planning on getting a tattoo. Adolescents with chronic acne or asthma do not have an increased risk for hepatitis B, since transmission has nothing to do with a diagnosis of acne. Overuse of muscles while playing sports is not related to development of hepatitis B.

Global Rationale: The adolescent who is most at-risk in the scenario presented is the teen who is planning on getting a tattoo. Adolescents with chronic acne or asthma do not have an increased risk for hepatitis B, since transmission has nothing to do with a diagnosis of acne. Overuse of muscles while playing sports is not related to development of hepatitis B.

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub: 

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: LO 9.1 Identify the major health concerns of the school-age and adolescent years.

Question 10

Type: MCSA

An obese adolescent who adamantly denies sexual activity has a positive pregnancy test, which was performed in the adolescent clinic. Which statement by the nurse is the most appropriate in this situation?

1. Tell me how you feel about your body image.

2. When was your last menstrual period (LMP)?

3. Lets discuss some activities that you have done within the past few months that could possibly lead to pregnancy.

4. Were you involved in a date rape and are you hesitant to speak about it?

Correct Answer: 3

Rationale 1: The nurse must help the adolescent realize that previous behaviors have led to a positive pregnancy test. The only response by the nurse that will accomplish this goal is for the nurse to ask a direct question in which the nurse and client search for an answer.

Rationale 2: The nurse must help the adolescent realize that previous behaviors have led to a positive pregnancy test. The only response by the nurse that will accomplish this goal is for the nurse to ask a direct question in which the nurse and client search for an answer.

Rationale 3: The nurse must help the adolescent realize that previous behaviors have led to a positive pregnancy test. The only response by the nurse that will accomplish this goal is for the nurse to ask a direct question in which the nurse and client search for an answer.

Rationale 4: The nurse must help the adolescent realize that previous behaviors have led to a positive pregnancy test. The only response by the nurse that will accomplish this goal is for the nurse to ask a direct question in which the nurse and client search for an answer.

Global Rationale: The nurse must help the adolescent realize that previous behaviors have led to a positive pregnancy test. The only response by the nurse that will accomplish this goal is for the nurse to ask a direct question in which the nurse and client search for an answer.

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub: 

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: LO 9.4 Apply assessment skills to plan data-gathering methods for nutrition, physical activity, and mental health status of youth.

Question 11

Type: MCSA

A mother reports that her adolescent is always late. The mother states, She was born late and has been late every day of her life. Which response should the nurse make to this mother?

1. You need to establish specific time frames for your adolescent and be certain she adheres to them.

2. You should not expect your adolescent to be an on-time individual unless you set specific alarms and then reinforce the value of being on-time.

3. You should not expect your adolescent to be on time. Teenagers are always late.

4. You have a major problem. There must be a lot of screaming in your home.

Correct Answer: 2

Rationale 1: The best response is to help the mother find a way to help the teen deal with the problem of lateness. The other responses will either create parentchild conflict and/or make assumptions about household communication.

Rationale 2: The best response is to help the mother find a way to help the teen deal with the problem of lateness. The other responses will either create parentchild conflict and/or make assumptions about household communication.

Rationale 3: The best response is to help the mother find a way to help the teen deal with the problem of lateness. The other responses will either create parentchild conflict and/or make assumptions about household communication.

Rationale 4: The best response is to help the mother find a way to help the teen deal with the problem of lateness. The other responses will either create parentchild conflict and/or make assumptions about household communication.

Global Rationale: The best response is to help the mother find a way to help the teen deal with the problem of lateness. The other responses will either create parentchild conflict and/or make assumptions about household communication.

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub: 

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: LO 9.3 Apply communication skills to interactions with school-age children, adolescents, and their families.

Question 12

Type: MCSA

When examining a 7-year-old, which action by the nurse would be most appropriate?

1. Allow the child to participate in the exam.

2. Ask the parent what kind of food the child likes to eat.

3. Ask the child whether he plays outside for at least 30 minutes a day.

4. Allow the child to decide whether he is ready for his next immunization.

Correct Answer: 1

Rationale 1: At this age, children have logical thought, and are learning about their bodies. Participating in the physical exam is appropriate for this age. The child can answer the question about food intake himself. Asking whether he plays outside for 30 minutes is fine, but children at this age need at least 60 minutes of activity, so the question will not gather appropriate information. It is not the childs decision whether he is ready for immunization, so do not ask this question.

Rationale 2: At this age, children have logical thought, and are learning about their bodies. Participating in the physical exam is appropriate for this age. The child can answer the question about food intake himself. Asking whether he plays outside for 30 minutes is fine, but children at this age need at least 60 minutes of activity, so the question will not gather appropriate information. It is not the childs decision whether he is ready for immunization, so do not ask this question.

Rationale 3: At this age, children have logical thought, and are learning about their bodies. Participating in the physical exam is appropriate for this age. The child can answer the question about food intake himself. Asking whether he plays outside for 30 minutes is fine, but children at this age need at least 60 minutes of activity, so the question will not gather appropriate information. It is not the childs decision whether he is ready for immunization, so do not ask this question.

Rationale 4: At this age, children have logical thought, and are learning about their bodies. Participating in the physical exam is appropriate for this age. The child can answer the question about food intake himself. Asking whether he plays outside for 30 minutes is fine, but children at this age need at least 60 minutes of activity, so the question will not gather appropriate information. It is not the childs decision whether he is ready for immunization, so do not ask this question.

Global Rationale: At this age, children have logical thought, and are learning about their bodies. Participating in the physical exam is appropriate for this age. The child can answer the question about food intake himself. Asking whether he plays outside for 30 minutes is fine, but children at this age need at least 60 minutes of activity, so the question will not gather appropriate information. It is not the childs decision whether he is ready for immunization, so do not ask this question.

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub: 

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: LO 9.5 Synthesize data from history and examination with knowledge of development to intervene with the school-age child, adolescent, and family during health supervision visits.

Question 13

Type: MCMA

The school health nurse recognizes that children who display certain characteristics are at risk for poor school performance. The nurse will, therefore, observe each school-age child for which characteristics?

Standard Text: Select all that apply.

1. Decreased ability to perform visual tracking.

2. Decreased auditory stimulation.

3. Decreased muscle tone.

4. Multiple dental caries.

5. Chronic tonsillitis.

Correct Answer: 1,2,3

Rationale 1: Children with vision, hearing, and muscle tone problems are at risk for poor school performance, since most school activities involve listening, seeing, and kinetic activity. School performance most likely would not be affected by dental caries and chronic tonsillitis.

Rationale 2: Children with vision, hearing, and muscle tone problems are at risk for poor school performance, since most school activities involve listening, seeing, and kinetic activity. School performance most likely would not be affected by dental caries and chronic tonsillitis.

Rationale 3: Children with problems with vision, hearing, and muscle tone are at risk for poor school performance, since most school activities involve listening, seeing, and kinetic activity. School performance most likely would not be affected by dental caries and chronic tonsillitis.

Rationale 4: Children with vision, hearing, and muscle tone problems are at risk for poor school performance, since most school activities involve listening, seeing, and kinetic activity. School performance most likely would not be affected by dental caries and chronic tonsillitis.

Rationale 5: Children with vision, hearing, and muscle tone problems are at risk for poor school performance, since most school activities involve listening, seeing, and kinetic activity. School performance most likely would not be affected by dental caries and chronic tonsillitis.

Global Rationale: Children with vision, hearing, and muscle tone problems are at risk for poor school performance, since most school activities involve listening, seeing, and kinetic activity. School performance most likely would not be affected by dental caries and chronic tonsillitis.

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub: 

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: LO 9.1 Identify the major health concerns of the school-age and adolescent years.

Question 14

Type: MCSA

A nurse obtains a nutritional health history from a 10-year-old child. Which of these food selections, if consumed on a regular basis, should lead the nurse to become concerned about the need for improving oral hygiene?

1. Peanuts and crackers

2. Sorbet and yogurt

3. Gummy bears and licorice

4. Fluoridated water

Correct Answer: 3

Rationale 1: Food items that stick to the teeth lead to dental caries. Items such as gummy bears and licorice all stick to the teeth and lead to dental caries. Foods such as peanut butter, crackers, sorbet, and yogurt do not stick to the teeth and are not considered foods that increase dental caries. Fluoridated water has been shown to decrease the incidence of dental caries.

Rationale 2: Food items that stick to the teeth lead to dental caries. Items such as gummy bears and licorice all stick to the teeth and lead to dental caries. Foods such as peanut butter, crackers, sorbet, and yogurt do not stick to the teeth and are not considered foods that increase dental caries. Fluoridated water has been shown to decrease the incidence of dental caries.

Rationale 3: Food items that stick to the teeth lead to dental caries. Items such as gummy bears and licorice all stick to the teeth and lead to dental caries. Foods such as peanut butter, crackers, sorbet, and yogurt do not stick to the teeth and are not considered foods that increase dental caries. Fluoridated water has been shown to decrease the incidence of dental caries.

Rationale 4: Food items that stick to the teeth lead to dental caries. Items such as gummy bears and licorice all stick to the teeth and lead to dental caries. Foods such as peanut butter, crackers, sorbet, and yogurt do not stick to the teeth and are not considered foods that increase dental caries. Fluoridated water has been shown to decrease the incidence of dental caries.

Global Rationale: Food items that stick to the teeth lead to dental caries. Items such as gummy bears and licorice all stick to the teeth and lead to dental caries. Foods such as peanut butter, crackers, sorbet, and yogurt do not stick to the teeth and are not considered foods that increase dental caries. Fluoridated water has been shown to decrease the incidence of dental caries.

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub: 

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: LO 9.4 Apply assessment skills to plan data-gathering methods for nutrition, physical activity, and mental health status of youth.

Question 15

Type: MCSA

The school health nurse is evaluating the home environment of several children as it relates to child safety. The nurse visits the home of each child and gathers the following data. Which activity places a child at greatest risk for bodily harm?

1. The parents are in a methadone program.

2. The parents consume alcohol on a daily basis.

3. The child is permitted to target practice with a revolver, unsupervised.

4. The child is a latchkey child.

Correct Answer: 3

Rationale 1: Of all the activities mentioned, the child who is playing with guns is most at risk for injury. The inappropriate behaviors, such as drug and alcohol use or past use, also place the child at risk, but the use of firearms is more risky. A latchkey child needs special attention but in regard to the situations given is not at the greatest risk of injury.

Rationale 2: Of all the activities mentioned, the child who is playing with guns is most at risk for injury. The inappropriate behaviors, such as drug and alcohol use or past use, also place the child at risk, but the use of firearms is more risky. A latchkey child needs special attention but in regard to the situations given is not at the greatest risk of injury.

Rationale 3: Of all the activities mentioned, the child who is playing with guns is most at risk for injury. The inappropriate behaviors, such as drug and alcohol use or past use, also place the child at risk, but the use of firearms is more risky. A latchkey child needs special attention but in regard to the situations given is not at the greatest risk of injury.

Rationale 4: Of all the activities mentioned, the child who is playing with guns is most at risk for injury. The inappropriate behaviors, such as drug and alcohol use or past use, also place the child at risk, but the use of firearms is more risky. A latchkey child needs special attention but in regard to the situations given is not at the greatest risk of injury.

Global Rationale: Of all the activities mentioned, the child who is playing with guns is most at risk for injury. The inappropriate behaviors, such as drug and alcohol use or past use, also place the child at risk, but the use of firearms is more risky. A latchkey child needs special attention but in regard to the situations given is not at the greatest risk of injury.

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub: 

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: LO 9.6 Plan with school-age children and adolescents to help them integrate activities to promote health and to prevent disease and injury.

Question 16

Type: MCMA

The school nurse is teaching a class about safety. The nurse will teach the children that they should wear protective athletic gear when participating in selected activities. Which of these activities require protective athletic gear?

Standard Text: Select all that apply.

1. Skateboarding

2. Playing football

3. Swimming

4. Playing lacrosse

5. Performing acrobatic tricks

Correct Answer: 1,2,4

Rationale 1: Any sport that includes body contact requires a child to wear protective equipment. These include skateboarding, football, and lacrosse. Swimming and acrobatics do not have any requirements for protective equipment.

Rationale 2: Any sport that includes body contact requires a child to wear protective equipment. These include skateboarding, football, and lacrosse. Swimming and acrobatics do not have any requirements for protective equipment.

Rationale 3: Any sport that includes body contact requires a child to wear protective equipment. These include skateboarding, football, and lacrosse. Swimming and acrobatics do not have any requirements for protective equipment.

Rationale 4: Any sport that includes body contact requires a child to wear protective equipment. These include skateboarding, football, and lacrosse. Swimming and acrobatics do not have any requirements for protective equipment.

Rationale 5: Any sport that includes body contact requires a child to wear protective equipment. These include skateboarding, football, and lacrosse. Swimming and acrobatics do not have any requirements for protective equipment.

Global Rationale: Any sport that includes body contact requires a child to wear protective equipment. These include skateboarding, football, and lacrosse. Swimming and acrobatics do not have any requirements for protective equipment.

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub: 

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: LO 9.5 Synthesize data from history and examination with knowledge of development to intervene with the school-age child, adolescent, and family during health supervision visits.

Question 17

Type: MCSA

A 9-year-old child who has been followed in the same pediatric home since birth is at the healthcare center for a well-child visit. A nurse who measures the height and weight of the child documents 35th percentile for height and 90th percentile for weight. How should the nurse interpret these data?

1. The child is beginning a growth spurt.

2. The child is obese and needs dietary counseling.

3. The parents are most likely below the 50th percentile for height and weight.

4. As soon as the child begins the adolescent growth spurt, the height and weight measurements will normalize.

Correct Answer: 2

Rationale 1: These data show that the child is disproportionate in height and weight. This childs weight is very high in comparison to height. The child would appear obese. Dietary history and counseling are the first steps. This child may also need an endocrine evaluation. This is not a growth spurt since height is what is referred to as a growth spurt. No assumptions about the parents can be made from the data presented. The statement about the adolescent growth spurt is incorrect for a child of this age.

Rationale 2: These data show that the child is disproportionate in height and weight. This childs weight is very high in comparison to height. The child would appear obese. Dietary history and counseling are the first steps. This child may also need an endocrine evaluation. This is not a growth spurt since height is what is referred to as a growth spurt. No assumptions about the parents can be made from the data presented. The statement about the adolescent growth spurt is incorrect for a child of this age.

Rationale 3: These data show that the child is disproportionate in height and weight. This childs weight is very high in comparison to height. The child would appear obese. Dietary history and counseling are the first steps. This child may also need an endocrine evaluation. This is not a growth spurt since height is what is referred to as a growth spurt. No assumptions about the parents can be made from the data presented. The statement about the adolescent growth spurt is incorrect for a child of this age.

Rationale 4: These data show that the child is disproportionate in height and weight. This childs weight is very high in comparison to height. The child would appear obese. Dietary history and counseling are the first steps. This child may also need an endocrine evaluation. This is not a growth spurt since height is what is referred to as a growth spurt. No assumptions about the parents can be made from the data presented. The statement about the adolescent growth spurt is incorrect for a child of this age.

Global Rationale: These data show that the child is disproportionate in height and weight. This childs weight is very high in comparison to height. The child would appear obese. Dietary history and counseling are the first steps. This child may also need an endocrine evaluation. This is not a growth spurt since height is what is referred to as a growth spurt. No assumptions about the parents can be made from the data presented. The statement about the adolescent growth spurt is incorrect for a child of this age.

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub: 

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: LO 9.5 Synthesize data from history and examination with knowledge of development to intervene with the school-age child, adolescent, and family during health supervision visits.

Question 18

Type: MCMA

The nurse is preparing to complete a health surveillance appointment with a school-age client and parents. Which observations would necessitate the need for further assessment by the nurse?

Standard Text: Select all that apply.

1. Client who does not make eye contact

2. Client with visible bruises in various stages of healing

3. Client holding a video game talking with parent

4. Client playing a card game with sibling

5. Client who appears red in the face while walking to exam room

Correct Answer: 1,2,5

Rationale 1: Nursing assessment begins with the first encounter with the client and the family. The nurse would want to further explore a client who does not make eye contact, who has bruises in various stages of healing, and a client who appears red in the face while walking to the exam room. All of these items may be clues to emotional issues, physical violence, and health related issues, such as hypertension. A client who is holding a video game and talking to the parent and a client who is playing a card game with a sibling are not observations that are abnormal for the school-age client.

Rationale 2: Nursing assessment begins with the first encounter with the client and the family. The nurse would want to further explore a client who does not make eye contact, who has bruises in various stages of healing, and a client who appears red in the face while walking to the exam room. All of these items may be clues to emotional issues, physical violence, and health related issues, such as hypertension. A client who is holding a video game and talking to the parent and a client who is playing a card game with a sibling are not observations that are abnormal for the school-age client.

Rationale 3: Nursing assessment begins with the first encounter with the client and the family. The nurse would want to further explore a client who does not make eye contact, who has bruises in various stages of healing, and a client who appears red in the face while walking to the exam room. All of these items may be clues to emotional issues, physical violence, and health related issues, such as hypertension. A client who is holding a video game and talking to the parent and a client who is playing a card game with a sibling are not observations that are abnormal for the school-age client.

Rationale 4: Nursing assessment begins with the first encounter with the client and the family. The nurse would want to further explore a client who does not make eye contact, who has bruises in various stages of healing, and a client who appears red in the face while walking to the exam room. All of these items may be clues to emotional issues, physical violence, and health related issues, such as hypertension. A client who is holding a video game and talking to the parent and a client who is playing a card game with a sibling are not observations that are abnormal for the school-age client.

Rationale 5: Nursing assessment begins with the first encounter with the client and the family. The nurse would want to further explore a client who does not make eye contact, who has bruises in various stages of healing, and a client who appears red in the face while walking to the exam room. All of these items may be clues to emotional issues, physical violence, and health related issues, such as hypertension. A client who is holding a video game and talking to the parent and a client who is playing a card game with a sibling are not observations that are abnormal for the school-age client.

Global Rationale: Nursing assessment begins with the first encounter with the client and the family. The nurse would want to further explore a client who does not make eye contact, who has bruises in various stages of healing, and a client who appears red in the face while walking to the exam room. All of these items may be clues to emotional issues, physical violence, and health related issues, such as hypertension. A client who is holding a video game and talking to the parent and a client who is playing a card game with a sibling are not observations that are abnormal for the school-age client.

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub: 

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: LO 9.2 Describe the general observations made of youth and their families as they come to the pediatric healthcare home for health supervision visits.

 

Ball/Bindler/Cowen, Principles of Pediatric Nursing 6th Ed. Test Bank

Copyright 2015 by Pearson Education, Inc.

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